Acute pancreatitis in children

Abstract

There are no drugs that cure or abate pancreatitis. The treatment of patients with mild and moderate episodes of pancreatitis (85%) is supportive and expectant. Central issues include the removal of the initiating process (if possible), relief of pain, and maintenance of fluid and electrolyte balance. Endoscopic retrograde cholangiopancreatography may be required for stone extraction in patients with biliary pancreatitis. Surgery is rarely required. The aims of treatment for patients with severe disease includes treatment of local, systemic, and septic complications in addition to those for mild and moderate disease. Homeostasis is maintained by the correction of hypocalcemia, anemia, hypoalbuminemia, electrolyte imbalances, and hypoxemia. A large number of medications have been used unsuccessfully in an attempt to halt the progression of the autodigestive process within the pancreas and to reduce pancreatic secretions. Nutritional support with either enteral or parenteral feeding is given. Intravenous antibiotics or selective bowel decontamination decrease mortality in patients with severe episodes of pancreatitis. The treatment for these individuals is often prolonged. Surgical treatment of traumatic pancreatitis with ductal rupture includes repair or resection. At times, simple drainage is performed and definitive surgery is deferred until later. Surgical treatment of severe pancreatitis includes debridement of necrotic and infected tissue. The emerging consensus appears to be that necrosectomy and local lavage or open management with planned re-exploration offers better survival than the conventional therapy of resection plus drainage alone.

Hereditary Angioedema Presenting as Recurrent Acute Pancreatitis

“…Children with uncomplicated acute pancreatitis do well and recover within 4 to 5 days, usually with only conservative treatment. 3 To the best of our knowledge, no case of HAE presenting as acute pancreatitis has been described to date in a child. Our review of the medical literature yielded 4 reports of adults in whom acute pancreatitis presented as an expression of already diagnosed HAE.…”

“…It may be caused by infections, metabolic disorders, immunologic conditions, blunt abdominal injuries, biliary stones, and drug toxicity. 3 Recurrent pancreatitis in children may be caused by hereditary disorders such as Shwachman syndrome, Pearson syndrome, mutation in CFTR (cystic fibrosis transmembrane conductance regulator), SPINK 1 (serine protease inhibitor, Kazal type 1) or PRSS1 (serine protease 1; trypsin 1). 3 It manifests as severe upper quadrant abdominal pain, vomiting, and sometimes fever, accompanied by an increase in serum lipase and amylase levels.…”

“…3 Recurrent pancreatitis in children may be caused by hereditary disorders such as Shwachman syndrome, Pearson syndrome, mutation in CFTR (cystic fibrosis transmembrane conductance regulator), SPINK 1 (serine protease inhibitor, Kazal type 1) or PRSS1 (serine protease 1; trypsin 1). 3 It manifests as severe upper quadrant abdominal pain, vomiting, and sometimes fever, accompanied by an increase in serum lipase and amylase levels. Children with uncomplicated acute pancreatitis do well and recover within 4 to 5 days, usually with only conservative treatment.…”

Internal pancreatic fistula in a child with pancreas divisum: An unusual manifestation of an uncommon anomaly

“…This treatment is to be considered only for a short duration (Յ3 wks) because sepsis complications increase with prolonged total parenteral nutrition use (4,16,17). Failure of conservative therapy should be considered if effusion from internal pancreatic fistula continues or if it recurs after reinstitution of oral feeding (5).…”