Pancreatitis associated with remote traumatic brain injury in children

Abstract

Vomiting, abdominal distension, and feeding intolerance are common findings following brain injury in children, and are usually attributed to the brain injury or to delayed gastric emptying: a specific cause is usually not sought. We report six children who developed mild to moderate pancreatitis at least 7 days following apparently isolated brain injury, a previously unreported association. Five of the six patients received drugs that are known or suspected pancreatotoxins; all recovered without changes in the medications. When children develop feeding intolerance or upper gastrointestinal symptoms following traumatic brain injury pancreatitis should be suspected.

Relationship Between Increases in Pancreatic Enzymes and Cerebral Events in Children After Traumatic Brain Injury

“…To our knowledge, this study is the first to determine the prevalence of increases in PE in children after severe TBI (57%) [12,15,16]. Not surprisingly, early increases in PE are associated with multisystem trauma.…”

“…Moreover, patients with TBI and ICH have a higher reported prevalence of pancreatitis (49-60%) [10,11]. In the only published study including children, Urban et al [12] described six cases of symptomatic pancreatitis after TBI with an increase in serum PE arising after the second week of admission and associated radiological findings on 2/6 of the patients. Our data support the conclusion that increases in PE occurs frequently in children with acute brain injuries.…”

“…In our study, we found that almost 40% of children developed increases in PE after their initial 24 h of hospitalization and that (i) intracranial hypertension and intracranial hemorrhage were independent risk factors and (ii) the development of delayed increases in PE was associated with increased PICU and hospital LOS. Urban et al [12] reported six cases of pancreatitis arising after the first week of injury in children after TBI. While they failed to determine a drug that was common among their cases, five of the six children described were found to have intracerebral hematomas.…”

“…The mechanisms of such injuries are not generally reported, although blunt injury to the abdomen from bicycle handlebars has been reported as a risk factor for pancreatic injury. Moreover, Urban et al [12] have reported delayed pancreatitis in six children following TBI. They hypothesized that medications related to TBI treatment may be the cause of pancreatitis.…”

Chapter Ten: Brain Injury Rehabilitation in Children with Non-Accidental Trauma

“…They reported only one of 25 patients with elevated lipase had clinical evidence of pancreatitis i.e., abdominal tenderness or pain, intolerance to enteral feeding, and/or paralytic ileus. One group found that symptomatic pancreatitis developed after seven days of injury in 6.6% of children with isolated head trauma had no evidence of associated abdominal trauma (Urban, Splaingard, & Werlin, 1994). Many children with head injury with intracranial bleeding may have elevation of pancreatic enzymes but unless correlated with clinical pancreatitis do not require further evaluation or limitation of feeding regimes.…”