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Acute pancreatitis in children: a 15-year review
G Haddock1, G Coupar, G G Youngson
1Department of Paediatric Surgery, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland.
Insights
This study reviewed childhood acute pancreatitis (AP), finding mumps and trauma as common causes. Prognostic criteria for adult AP were of limited value in children, suggesting a need for modification.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Pancreatology
Background:
- Acute pancreatitis (AP) in children is less common than in adults, with varying etiologies and presentations.
- Understanding the specific challenges in pediatric AP is crucial for effective diagnosis and management.
Purpose of the Study:
- To review the causes, symptoms, diagnosis, treatment, and outcomes of acute pancreatitis in children.
- To evaluate the applicability of adult prognostic criteria for assessing severity in pediatric AP.
Main Methods:
- A retrospective analysis of 49 children diagnosed with AP between 1978 and 1992 across three Scottish pediatric centers.
- Review of medical records, including presenting symptoms, diagnostic imaging (ultrasound), management strategies, and patient outcomes.
Main Results:
- The most frequent causes identified were mumps (39%) and trauma (14%), with 12 cases having an unknown etiology.
- Abdominal pain and vomiting were the most common symptoms (80%). Ultrasound was the primary imaging modality, with abnormal findings in 24 of 34 patients.
- Most children (82%) were managed conservatively; 12% required early laparotomy. Prognostic criteria used for adults showed limited value in identifying severe cases in this pediatric cohort.
Conclusions:
- Mumps and trauma are significant causes of pediatric AP. Ultrasound is a valuable diagnostic tool.
- Current adult prognostic criteria for AP severity are of doubtful value in children and require further investigation and potential modification for pediatric use.
Aim:
To review the aetiology, presentation, diagnosis, management, and sequelae of acute pancreatitis (AP) in children and to assess the relevance of prognostic criteria used to assess severity in adult AP.
Method:
A retrospective review (1978 through 1992) of childhood AP managed in three Scottish paediatric centres.
Results:
Forty-nine cases of AP (34 male, 15 female) were reviewed (mean age, 7.1 years). The presenting features were abdominal pain and vomiting (80%), abdominal tenderness (73%), and parotid enlargement (22%); back pain was rare (8%). Ultrasound scan (US) findings were abnormal for 24 of 34 patients. Forty-one (82%) were managed conservatively. Six (12%) underwent early laparotomy; three (6%) underwent laparotomy after trauma. Five required subsequent definitive surgery. One patient died. Thirty-five (70%) suffered no sequelae, and five (10%) had further acute pancreatitis. Only half of the eight Imrie prognostic criteria had been recorded in these patients; only three were judged to have severe AP by the criteria. Other "clinically severe" cases were not identified.
Conclusion:
The most common causes of AP were mumps (39%) and trauma (14%); in 12, no cause was identified. US was the most useful imaging tool. The Imrie criteria were of doubtful value but warrant further prospective analysis and possible modification for children.