Journal List > Korean J Pediatr Gastroenterol Nutr > v.13(1) > 1043479

Korean J Pediatr Gastroenterol Nutr. 2010 Mar;13(1):58-65. Korean.
Published online March 31, 2010.  https://doi.org/10.5223/kjpgn.2010.13.1.58
Copyright © 2010 The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition
Clinical Features of Acute Pancreatitis in Children
Jung Ho Seo, M.D., Seong Heon Kim, M.D., Sang Geon Jeong, M.D.,* and Jae Hong Park, M.D.
Department of Pediatrics, School of Medicine, Pusan National University, Busan, Korea.
*Department of Pediatrics, Good Gangahn Hospital, Busan, Korea.

Responsible author (Email: jhongpark@pusan.ac.kr )
Received February 19, 2010; Accepted March 12, 2010.

Abstract

Purpose

Since there are few studies involving acute pancreatitis in children, we reviewed our experience with this medical condition to describe the clinical features.

Methods

A retrospective analysis was conducted by reviewing the medical records of 41 patients with AP who were admitted to the Department of Pediatrics of Pusan National University Hospital between January 1996 and June 2007.

Results

Twenty males and 21 females (mean age, 8.7±4.5 years) were included. In 22 patients (53.7%), no definitive causes were found. The most common etiologies were choledochal cysts (22.0%). Necrotizing pancreatitis was diagnosed in 5 patients (12.2%), and recurrent acute pancreatitis in 4 patients (9.8%). CT findings included pancreatic swelling (43.9%), peripancreatic fluid collection (29.3%), ascites (24.4%), and peripancreatic fat necrosis (12.2%). Serum amylase and lipase levels at diagnosis were 535.3±553.2 and 766.2±723.6 U/L, respectively, and were normalized within 1 week in 22 and 14 patients, respectively. On the basis of the Balthazar scale, 2 patients were diagnosed with severe AP. In 4 patients (9.8%), a surgical procedure was indicated. Major complications included ascites (32.3%), sepsis (16.1%), and pseudocyst and renal impairments (12.9%). Two patients died from multi-organ failure.

Conclusion

The etiologies of AP in children are varied. Most children have a single episode and a self-limited course. However, AP of childhood still carries significant morbidity and mortality. Early diagnosis, appropriate treatment according to disease severity, and management of complications are important.

Keywords: Acute pancreatitis; Children

Tables


Table 2
Presenting Symptoms on Admission
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Table 3
Etiology of Acute Pancreatitis in Children
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Table 4
Initial Laboratory Findings
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Table 5
Radiologic Findings
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Table 6
Normalization of Serum Amylase and Lipase Levels
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Table 7
Prognosis Scoring System
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References
1. Lopez MJ. The changing incidence of acute pancreatitis in children: a single-institution perspective. J Pediatr 2002;140:622–624.
2. Nydegger A, Hein RG. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children's Hospital, Melbourne. J Gastroenterol Hepatol 2007;22:1313–1316.
3. Werlin SL, Kugathasan S, Frautschy BC. Pancreatitis in children. J Pediatr Gastroenterol Nutr 2003;37:591–595.
4. John HC, Ranson BM. Diagnostic standards for acute pancreatitis. World J Surg 1997;21:136–142.
5. Cho JH, Lee TS, Ko YG, Oh SM. Acute pancreatitis in children. J Korean Assoc Pediatr Surg 1996;2:17–25.
6. Choi YI, Seo JK. Evaluation of severity of childhood pancreatitis with multiple factor scoring systems. J Korean Pediatr Soc 1995;12:1653–1663.
7. Park JE, Kim KM. Etiology and analysis of severity in childhood pancreatitis. Korean J Pediatr Gastroenterol Nutr 1999;2:194–203.
8. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818–829.
9. Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174:331–336.
10. Haddock G, Youngson CG. Acute pancreatitis in children: a 15-year review. J Pediatr Surg 1994;29:719–722.
11. Nydegger A, Couper RT, Oliver MR. Childhood pancreatitis. J Gastroenterol Hepatol 2006;21:499–509.
12. Choi WI, Ahn YH, Park CS, Jo J, Yoo BD, Lee DP. A clinical study of acute pancreatitis. J Korean Soc Emerg Med 1998;9:277–285.
13. Eichelberger MR, Hoelzer DJ, Koop CE. Acute pancreatitis: the difficulties of diagnosis and therapy. J pediatr Surg 1983;17:244–254.
14. Sl Blamey;CW. Imrie;J. D'Neil;WH. Gilmour,DC Carter.Prognostic factors in acute pancreatitis. Gut 1984;25:1340–1346.
15. Ranson JHC, Rifkind KM, Roses DF, Fink SO, Eng K, Spencer FC. Prognostic signs and the roles of operative management in acute pancreatitis. Surg Gynecol Obstet 1974;139:69–81.
16. Wilson C, Heath DI, Imrie CW. Prediction of outcome in acute pancreatitis comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 1990;77:1260–1264.
17. Tran DD, Cuesta MA. Evaluation of severity in patients with acute pancreatitis. Am J Gastroenterol 1992;87:604–608.
18. Chatzicostas C, Roussomoustakaki M, Vardas E, Romanos J, Kouroumalis EA. Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II and III scoring systems in predicting acute pancreatitis outcome. J Clin Gastroenterol 2003;36:253–260.
19. Singer MV, Gyr K, Sarles H. Revised classification of pancreatitis. Report of the Second International Symposium on the Classification of Pancreatitis in Marseille, France, March 28-30, 1984. Gastroenterology 1985;89:683–685.
20. Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ 2004;328:1407.
21. Frank AW, Maik K, Ina H, Thomas F, Christoph AJ, Hans G, et al. Effects of octreotide in acute hemorrhagic necrotizing pancreatitis in rats. J Gastroenterol Hepatol 2007;22:1872–1876.
22. Seta T, Noguchi Y, Shimada T, Shikata S, Fukui T. Treatment of acute pancreatitis with protease inhibitors: a meta-analysis. Eur J Gastroenterol Hepatol 2004;16:1287–1293.
23. Stefan H, Markus S, Valentin R, Pierre AC. Evidence-based treatment of acute pancreatitis; a look at established paradigms. Ann Surg 2006;243:154–168.
24. Osborne DH, Imrie CW, Carter DC. Biliary surgery in the same admission for gallstone-associated acute pancreatitis. Br J Surg 1981;68:758–761.
25. Ziegler DW, Long JA, Philippart AI. Pancreatitis in childhood. Ann Surg 1988;207:s257–s261.