BackgroundThe diagnosis of pediatric pancreatitis has been increasing over the last 15 years but the etiology of this is uncertain. The population of pre-adolescent patients with pancreatitis in the emergency department has not been specifically described. Our objective was to determine the characteristics of these patients to illuminate this population and disease in order to better identify them and avoid a delay in diagnosis and treatment.MethodsThis was a retrospective descriptive study of consecutive pediatric patients under the age of 13 years between 2006 and 2016 who presented to our pediatric emergency department with a diagnosis of atraumatic pancreatitis. Patient characteristics, lab and imaging results, identified etiology of pancreatitis, and recurrence rates were recorded and evaluated.ResultsThere were 139 visits, of which 85 were for a first episode of acute pancreatitis, and 54 were patients with an episode of recurrent pancreatitis. The median age for all visits was 8 years (IQ range 5–11). Of the acute cases, 26% had uncertain or undetermined etiologies of which half were thought to likely be viral related; 20% had systemic inflammatory or autoimmune diseases; 19% were associated with medications, with the most common being valproic acid; 16% were cholelithiasis-related; and 15% were found to have a genetic, congenital or structural etiology. No patients had elevated triglycerides. Those with cholelithiasis and genetic or structural defects were found to have a higher recurrence rate than those with other etiologies. There were only four patients diagnosed with chronic pancreatitis.ConclusionsThe etiology of pancreatitis in pre-adolescent children has a different distribution than in adolescents and adults, with gallstone disease less frequent and concurrent contributing illness more common. Patients on pancreatitis-causing medications or with known genetic risk or structural pancreatic problems should be tested for pancreatitis if presenting with concerning symptoms. Hypertriglyceridemia and chronic pancreatitis with evidence of pancreatic exocrine insufficiency is uncommon in this population.

Background Pediatric pancreatitis is increasing, whether due to an increase in cholelithiasis or factors such as increased awareness and testing. This study was to describe previously undescribed pre-adolescent children with pancreatitis to illuminate this population and clarify who should be screened for pancreatitis. Methods This is a descriptive retrospective study of emergency department patients <13 years old over 10 years with the diagnosis of pancreatitis. Demographics, laboratory values, imaging results and final diagnoses/etiologies were recorded and evaluated using descriptive statistics. Results 100 patients presented with acute pancreatitis and median age of 8 years (IQ range 5-11). 25% were attributed to an unknown etiology. 16 were medication induced, 13 genetic/congenital/structural, 14 traumatic/post surgical, 14 had gallstones, and 17 had autoimmune or systemic illness-related pancreatitis. 29 patients had recurrent pancreatitis. Conclusions Cholelithiasis is a much less frequent etiology in children than in adults. Genetic/structural factors represent a larger proportion of acute cases and higher proportion of recurrent pancreatitis. Concurrent systemic and viral illnesses are more common than in adults. Patients on pancreatitis-causing medications or with known genetic/structural issues should be tested for pancreatitis. Patients without risk factors rarely developed recurrent pancreatitis. Hypertriglyceridemia was not found to be an etiology. Chronic pancreatitis was uncommon.