Pancreatitis in children: diagnosis and etiology in 57 patients

Camp, Joan M. Van; Polley, Theodore Z.; Coran, Arnold G.

doi:10.1007/bf00179449

Cited by 15 publications

(10 citation statements)

References 14 publications

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“…Chronic pancreatitis leading to CBD obstruction and jaundice is quite uncommon in children (5,8,9). Idiopathic fibrosing pancreatitis (IFP) is a rare clinical entity and a rare cause of biliary obstruction in children and adolescents.…”

Section: Introductionmentioning

confidence: 98%

Idiopathic Fibrosing Pancreatitis Presenting with Obstructive Jaundice in a Child

Keil¹,

Šnajdauf²,

Kalousová³

et al. 2001

Eur J Pediatr Surg

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Idiopathic fibrosing pancreatitis (IFP) is a rare cause of obstructive jaundice in children. The obstruction is caused by circumferential compression of the intrapancreatic portion of the common bile duct (CBD). Various forms of biliary decompression, including surgical sphincteroplasty, choledochoduodenostomy, and Roux-en-Y choledochojejunostomy are employed as a treatment. We report a 14-year-old boy with IFP who was successfully treated by a temporary drainage of compressed CBD with the help of a stent placed by endoscopic retrograde cholangiopancreatography (ERCP). The diagnosis of IFP was confirmed histologically after open surgery. The patient remains well after 3.5 years of follow-up with no evidence of pancreatic insufficiency. This report offers an additional case of IFP causing obstructive jaundice treated by temporary internal drainage of CBD, which is safer and less invasive than biliodigestive surgical decompression.

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Section: Introductionmentioning

confidence: 98%

Idiopathic Fibrosing Pancreatitis Presenting with Obstructive Jaundice in a Child

Keil¹,

Šnajdauf²,

Kalousová³

et al. 2001

Eur J Pediatr Surg

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“…In the series of children with pancreatitis in Van Camp et al . 15/41 had a normal abdominal ultrasound, demonstrating the difficulty of relying upon ultrasound for a diagnosis 9 . Unfortunately, in our patient the pancreas was not visualised at ultrasound due to overlying bowel.…”

Section: Discussionmentioning

confidence: 74%

“…The role for serum amylase measurements in paediatric abdominal pain requires evaluation, as the majority of children with pancreatitis have an elevated serum amylase measurement 9 . There is also a need to evaluate the role of abdominal ultrasonography in paediatric pancreatitis, as it is a commonly used diagnostic modality 8 and is a commonly used investigation in adult practice.…”

Section: Discussionmentioning

confidence: 99%

Gallstone pancreatitis in a 6‐month‐old child

King

Reddy

Pitham

et al. 2007

J Paediatrics Child Health

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Key Points1 Pancreatitis in children remains an uncommon clinical phenomenon. 2 Increased use of parenteral nutrition and increased survival from extended episodes of sepsis is likely to lead to increased episodes of cholelithiasis, cholecystitis and choledocholithiasis. 3 Gallstone pancreatitis is likely to become a more common cause of severe abdominal pain in children.tinued to vomit non-bile-stained material but tolerated increasing feeds over the first 3 days of admission. Repeat investigations on day 3 revealed a reduction in the white blood cell count (13.6) but a rise in total bilirubin (46, normal 0-15 µmol/L), conjugated bilirubin (26, normal 0-10 µmol/L) and alanine aminotransferase (316, normal <55 IU/ L). The ALP (327, normal 100-350 IU/L) and GGT (215) were at the upper level of normal limits. Blood cultures grew Staphylococcus epidermis epidermis, resulting in a change in antibiotics to vancomycin and cefotaxime. The mid-stream urine was clear. Vomiting and poor oral intake continued into days 4 and 5 and further investigations on day 4 revealed a raised amylase (256, normal 36-128 IU/L) and a normal lipase (19, 8-57 IU/L).Upper abdominal ultrasonography revealed a 'thin-walled gallbladder with no gallstones within, intra-and extra-hepatic bile duct dilatation and a common bile duct (CBD) measuring 4.4 mm in diameter'. The pancreas was not visualised due to overlying bowel. As the child's clinical situation was not improving, he was transferred to a tertiary paediatric hospital for surgery. Open cholecystectomy was performed to facilitate both a cholangiogram and CBD exploration. Macroscopically the gall bladder was thick-walled but allowed a cholangiogram catheter to be introduced, revealing two stones in the proximal CBD but no stones in the gall bladder itself. A separate cystic duct incision was required for introduction of a 4 Fr Fogarty embolectomy catheter and withdrawal of both stones. A further cholangiogram revealed no further filling defects. Cholecystectomy was performed because of the thickened gall bladder and the risk of cystic duct stenosis. The pancreas was not visualised at the time of operation. Subsequent histological analysis of the gall bladder revealed signs of both 'acute and chronic inflammation'. The patient remains well almost 4 years post-surgery.

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“…Inflammatory changes in the pancreas may be associated with varying degrees of pancreatic duct dilatation and progressive or permanent loss of pancreatic function. Pancreatitis is rare in children and chronic pancreatitis is rarer still [1,4,8]. Internal pancreatic fistulae following chronic pancreatitis is therefore not a commonly reported condition in children.…”

Section: Discussionmentioning

confidence: 92%

“…Pancreatitis is termed 'chronic' when irreversible changes have taken place [1][2][3][4]. The radiological hallmarks are calcification and/or ductal dilatation.…”

Section: Introductionmentioning

confidence: 99%

The leaking pancreatic duct in childhood chronic pancreatitis

et al. 2006

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The leaking pancreatic duct in childhood chronic pancreatitis presents with ascites and pleural effusion and is a potentially lethal condition. Seven children with this condition were seen in the period 2003-2006. The correct diagnosis was not entertained till a raised serum amylase was discovered. The diagnosis was confirmed by very high levels of amylase in the aspirated abdominal or pleural fluid. Computerized tomogram was the most useful imaging study and demonstrated a dilated pancreatic duct. All children were operated within 6 days of diagnosis by a Puestow's procedure in six and peripancreatic drainage in one. Six children made a prompt and lasting recovery after a Puestow's procedure while one child, also suffering from metastatic neuroblastoma, died in the immediate post operative period after peripancreatic drainage. We recommend prompt and definitive surgical management of this potentially lethal condition.

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Pancreatitis in children: diagnosis and etiology in 57 patients

Cited by 15 publications

References 14 publications

Idiopathic Fibrosing Pancreatitis Presenting with Obstructive Jaundice in a Child

Idiopathic Fibrosing Pancreatitis Presenting with Obstructive Jaundice in a Child

Gallstone pancreatitis in a 6‐month‐old child

The leaking pancreatic duct in childhood chronic pancreatitis

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