Risk Factors, Clinical Features, and Outcomes of Acute Pancreatitis in Children in Endemic Zone of Ascariasis in Eastern Bihar: A Hospital-Based Study

Abstract

This study aims to describe the etiology, clinical features, and outcomes of acute pancreatitis (AP) in children in an endemic area of hepatobiliary ascariasis. MethodsThis retrospective observational study included acute pancreatitis (AP) patients in the age group of 2-15 years from January 2019 to January 2022. Demographic profile, risk factors, clinical features, laboratory imaging, and outcome data were collected and analyzed. ResultsA total of 40 patients comprising of 21 males (52.5%) and 19 females (47.5%) were included. The median age of the diagnosis of AP was 8.3 years (range: 4-14 years). Biliary ascariasis was the most frequent etiology of AP (n=18, 45%), followed by gallbladder (GB) stone (n=6, 12%), trauma (n=1, 2.5%), hepatitis (n=1, 2.5%), valproate drug (n=1, 2.5%), and GB sludge (n=1, 2.5%). In clinical features, all cases had pain in the abdomen (n=40, 100%), followed by fever (n=9, 22.5%), nausea/vomiting (n=33, 82.5%), jaundice (n=2, 5%), and anemia (n=2, 5%). Three (7.5%) patients developed complications such as shock, pseudocyst, and necrotizing pancreatitis, respectively. The average median hospital stay was nine days (range: 4-20 days). No mortality occurred in our study. ConclusionsThis study revealed a high prevalence (12-13 cases/year) of AP in children in this area. Biliary ascariasis (45%) emerged as the commonest risk factor. Most of the cases suffered from mild AP (92%) and so recovered completely without any complication.

Potential Predictors of Severe and Recurrent Pancreatitis in Children

“…Ten (15.6%) patients developed complications such as pseudocysts and necrotizing pancreatitis, and the average median hospital stay was 8.2 days, which was similar to that reported by another study. 23 Severe pancreatitis occurred more commonly in young patients (10.4 vs 12 years, P = 0.048), and recurrent pancreatitis occurred more commonly in older patients (13.7 vs 11.4 years. P = 0.022).…”

Review of acute pancreatitis in children in India

“…Bhattacharya et al . [ 12 ] (June 21, 2022, Cureus) noted the incidence of AP cases as 12–13 cases/year, and the mean age of the patient was 8.3 years. Vepakomma Deepti et al .…”

“…Data about the etiological spectrum collected from articles mentioning the most common causes are described in Table 1 . [ 11 12 13 14 15 16 17 ] The articles included show that idiopathic is the most common cause of AP ranging from 21 to 82.25%, followed by gallstone (10–23.3%), pancreatic structural abnormality (9.67–15%), biliary ascariasis (45–60%), and blunt trauma (6.45–21%).…”

Acute necrotising pancreatitis from ascariasis in a gravid patient

“…However, biliary ascariasis may be a common risk factor in endemic areas, as shown in a hospital-based study by Bhattacharya et al, where ascariasis was the most frequent aetiology of acute pancreatitis in a locality in India. 8 Thus, parasitism may be a relatively more common cause of acute pancreatitis in the Philippines, where a national survey of soil-transmitted helminthic infections showed endemic levels in the three regions of the country. 9 …”