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Pancreatitis in children--experience with 43 cases
C Y Yeung1, H C Lee, F Y Huang
1Department of Paediatrics, Mackay Memorial Hospital, Taipei Taiwan, ROC.
Insights
Pediatric pancreatitis, though rare, can lead to severe outcomes. This study reviewed 43 children, identifying trauma, systemic disease, and structural issues as key causes, emphasizing early diagnosis for better outcomes.
Area of Science:
- Pediatrics
- Gastroenterology
- Clinical Medicine
Background:
- Pancreatitis in children is uncommon but associated with significant morbidity and mortality.
- A review of 43 pediatric cases over 10 years was conducted.
- The study highlights the importance of understanding diverse etiologies in pediatric pancreatitis.
Purpose of the Study:
- To analyze the causes, clinical presentation, and outcomes of pancreatitis in children.
- To review diagnostic modalities and management strategies for pediatric pancreatitis.
- To discuss the association between pancreatitis and structural anomalies in children, including the first review of pancreatitis in Chinese children.
Main Methods:
- Retrospective review of 43 children (ages 2-18) diagnosed with pancreatitis over 10 years.
- Diagnosis based on intra-operative findings or clinical and laboratory evidence of pancreatic inflammation.
- Etiologies categorized into trauma, systemic disease, structural disease, toxins/drugs, and idiopathic.
Main Results:
- Trauma was the most common cause (16 cases), followed by systemic disease (10), structural disease (8), and toxins/drugs (4); 5 cases were idiopathic.
- Abdominal pain (95%) and vomiting (56%) were the most frequent symptoms.
- Morbidity included pseudocyst (10 cases), relapse (4), and hyperglycemia (4); one fatal outcome occurred.
Conclusions:
- Pediatric pancreatitis arises from diverse causes and can lead to severe complications.
- Prompt diagnosis, vigilant monitoring, and proactive treatment are crucial for minimizing morbidity and mortality.
- Early recognition and management are key to improving outcomes in pediatric pancreatitis cases.
Unlabelled:
Pancreatitis in children is not common and can be associated with severe morbidity and mortality. We encountered 43 children, ranging in age from 2 to 18 years, with pancreatitis over the past 10 years. The diagnosis of pancreatitis was made in those patients who showed: (1) significant intra-operative pathology or; (2) clinical findings of pancreatic inflammation and laboratory confirmation. More than one third (16 cases) of the cases were due to trauma, other causes included systemic disease (10), structural disease (8), and toxins or drugs (4). Five cases were classified as idiopathic. Most of the patients presented with abdominal pain (95%) and vomiting (56%). Jaundice was found in 7 patients and an abdominal mass in 2. Morbidity included pseudocyst (10), relapse (4), hyperglycaemia (4) and miscellaneous problems. Eight (50%) of the patients with trauma and 6 (86%) of the patients with structural diseases required surgery. Other patients were managed conservatively with bowel rest, gastric decompression, intravenous fluid and total parenteral nutrition. One case had a fatal outcome. All the survivors did well in long term follow up. Relevant literature has been reviewed and the sensitivity of various diagnostic modalities compared and discussed. A lesser known association between pancreatitis and structural anomalies such as choledochal cyst is discussed. To our knowledge, the present review is the first on pancreatitis in Chinese children.
Conclusion:
Pancreatitis can occur from a wide variety of causes and may result in severe complications. Early diagnosis, close monitoring and aggressive intervention are mandatory to reduce morbidity and mortality.