Surgical Therapy and Follow-up of Pancreatitis in Children

Abstract

For acute pancreatitis in childhood, operative treatment by inner drainage is necessary and effective only in case of complications, should conservative treatment fail. In children with chronic relapsing pancreatitis, the good exocrine and the normal endocrine function of the pancreas in these patients justified the early operation. Timely treatment is recommended in cases with typical changes of the pancreatic duct so as to shorten the relapsing clinical problems of the children and to maintain the function of the pancreas.

Surgical management of a pancreaticopleural fistula in a child with chronic pancreatitis

“…Pancreatopleural fistulas secondary to chronic pancreatitis in the pediatric age group is rare and, in the past, has been reported only 3 times [2][3][4]. In 6 of the patients, an obvious cause for the pancreatitis (as was the case with our patient) was not elucidated, and in the seventh, hereditary pancreatitis was identified as the primary etiologic factor.…”

“…This would add further support to early aggressive surgical management in such patients, particularly in the presence of a significant pancreatic ductal abnormality and fistula, as has been described in previous patients [2][3][4]9]. As to whether this operation results in an improvement of pancreatic function and reduces the longterm risk of pancreatic cancer is yet to be proven [10], but it is worthwhile considering this approach to relieve symptoms and improve the quality of life in these patients.…”

“…Causes include juvenile tropical pancreatitis, hereditary pancreatitis, hypercalcemia, hyperlipidemia, and cystic fibrosis [1]. It can result in both exocrine and endocrine dysfunction; however, the formation of a fistula between the pancreas and pleural space has been rarely reported in children [2][3][4]. We will present an additional case and surgical management of this difficult clinical problem.…”

Acute pancreatitis in children

“…• Accepted indications for surgical treatment include traumatic pancreatitis with disruption of a major duct, persistent severe biliary pancreatitis with an obstructing gallstone that cannot be removed endoscopically, infected pancreatic necrosis, and drainage of pancreatic abscess when percutaneous drainage has failed [22][23][24]. • The repair or resection of traumatic injuries such as ruptured ducts can only be accomplished surgically.…”

“…Cultures must always be obtained. The emerging consensus appears to be that necrosectomy and local lavage or open management with planned re-exploration offers better survival than conventional therapy of resection plus drainage alone [21,22]. Surgical treatment of sterile necrosis remains controversial but is probably not indicated.…”