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40 - Acute and chronic pancreatitis in children

from Part IV - Abdomen

Published online by Cambridge University Press:  08 January 2010

By
Pierre Tissières  and
Claude Le Coultre
Edited by
Mark D. Stringer ,
Keith T. Oldham  and
Pierre D. E. Mouriquand
Pierre Tissières
Affiliation:
Multidisciplinary Paediatric Intensive Care Unit, Bicêtre Hospital, Le Kremlin-Bicêtre, France
Claude Le Coultre
Affiliation:
Paediatric Surgery Department, Children's Hospital, Geneva, Switzerland
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Pancreatitis in children is relatively rare but may be increasing in frequency. Two main patterns of disease exist in children: acute pancreatitis, which accounts for 75% of all cases, is abrupt in onset but usually self-limiting; and chronic pancreatitis, in which pancreatic inflammation and gland destruction are progressive.

Acute pancreatitis

Etiology

Although the pathophysiology and functional consequences of acute pancreatitis in children are identical to those observed in adults, etiology differs significantly (Table 40.1). In children, drugs and toxins (12%–18%) and systemic disease (12%–35%) are major causes of acute pancreatitis. Abdominal trauma is another important cause of acute pancreatitis, accounting for between 14% and 29% of cases; it may be related to blunt abdominal trauma, surgical trauma, or, in some instances, to child abuse. Up to 25% of cases are idiopathic, although this proportion is less in more recent series. Recurrent acute pancreatitis, characterized by repeated acute episodes, is associated with obstructive disease, such as pancreatic ductal abnormalities, biliary tract obstruction, duplication cyst and biliary lithiasis. Pancreas divisum is the most frequently encountered pancreatic malformation present in as many as 10%–15% of patients undergoing magnetic resonance cholangiopancreatography; this anomaly is associated with 2.5% of acute pancreatitis in children. Acute pancreatitis can occur within the first month of life, but most cases present around the age of 5 years and during adolescence.

Diagnosis

Diagnosis of acute pancreatitis can be difficult and outcome unpredictable at onset, as several local, regional and systemic insults can hamper the diagnosis and affect the prognosis.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
 , pp. 519 - 528
Publisher: Cambridge University Press
Print publication year: 2006

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References

Werlin, S. L., Kugathasan, S., & Frautschy, B. C.Pancreatitis in children. J. Pediatr. Gastroenterol. Nutr. 2003; 37:591–595.CrossRefGoogle ScholarPubMed
Benifla, M. & Weizman, Z.Acute pancreatitis in childhood: analysis of literature data. J. Clin. Gastroenterol. 2003; 37:169–172.CrossRefGoogle ScholarPubMed
Hendren, W. H., Greep, J. M., & Patton, A. S.Pancreatitis in childhood: experience with 15 cases. Arch. Dis. Child. 1965; 40:132–145.CrossRefGoogle ScholarPubMed
Fonkal, E. W. srud, Henney, R. P., Riemenschneider, T. A.et al.Management of pancreatitis in infants and children. Am. J. Surg. 1968; 116:198–203.Google Scholar
Moossa, A. R.Acute pancreatitis in childhood. Progr. Pediatr. Surg. 1972; 4:111–127.Google ScholarPubMed
Buntain, W. L., Wood, J. B., & Wooley, M. M.Pancreatitis in childhood. J. Pediatr. Surg. 1978; 13:143–148.CrossRefGoogle ScholarPubMed
Eichelberger, M. R., Hoelzer, D. J., & Koop, C. E.Acute pancreatitis: the difficulties of diagnosis and therapy. J. Pediatr. Surg. 1982; 17:244–54.CrossRefGoogle ScholarPubMed
Forbes, A., Leung, J. W. C., & Cotton, P. B.Relapsing acute and chronic pancreatitis. Arch. Dis. Child. 1984; 59:927–934.CrossRefGoogle ScholarPubMed
Tam, P. K. H., Saing, H., Irving, I. M.et al. Acute pancreatitis in children. J. Pediatr. Surg. 1985; 20:58–60.CrossRefGoogle ScholarPubMed
Beshlian, K. & Ryan, J. A.Pancreatitis in teenagers. Am. J. Surg. 1986; 152:133–138.CrossRefGoogle ScholarPubMed
Synn, A. Y., Mulvihill, S. J., & Fonka, E. W. srudSurgical management of pancreatitis in childhood. J. Pediatr. Surg. 1987; 22:628–632.CrossRefGoogle ScholarPubMed
Ziegler, D. W., Long, J. A., Philippart, A. I.et al. Pancreatitis in childhood: experience with 49 patients. Ann. Surg. 1988;207:257–261.CrossRefGoogle ScholarPubMed
Weizman, Z. & Durie, P. R.Acute pancreatitis in childhood. J. Pediatr. 1988; 113:24–29.CrossRefGoogle ScholarPubMed
Vane, D. W., Grosfeld, J. L., West, K. W.et al. Pancreatic disorders in infancy and childhood: experience with 92 cases. J. Pediatr. Surg. 1989; 24:771–776.CrossRefGoogle ScholarPubMed
Haddock, G., Coupar, G., Youngson, G. G.et al. Acute pancreatitis in children: a 15-year review. J. Pediatr. Surg. 1994; 29:719–722.CrossRefGoogle ScholarPubMed
Yeung, C. Y., Lee, H. C., Huang, F. Y.et al. Pancreatitis in children – experience with 43 cases. Eur. J. Pediatr. 1996; 155:458–463.CrossRefGoogle ScholarPubMed
Jordan, S. C. & Ament, M. E.Pancreatitis in children and adolescents. Pediatrics 1977; 91:211–216.CrossRefGoogle ScholarPubMed
Berney, T., Belli, D., Bugmann, P.et al. Influence of severe underlying pathology and hypovolemic shock on the development of acute pancreatitis in children. J. Pediatr. Surg. 1996; 31:1256–1261.CrossRefGoogle ScholarPubMed
Tissieres, P., Simon, L., Debray, D.et al. Acute pancreatitis after orthotopic liver transplantation in children: incidence, contributing factors, and outcome. J. Pediatr. Gastroenterol. Nutr. 1998; 26:315–320.CrossRefGoogle ScholarPubMed
Steinberg, W. M., Goldstein, S. S., Davis, N. D.et al. Diagnostic assays in acute pancreatitis. Ann. Intern. Med. 1985; 102:576–580.CrossRefGoogle ScholarPubMed
Wilson, C., Heads, A., Shenkin, A., & Imrie, C. W.C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br. J. Surg. 1989; 76:177–781.CrossRefGoogle ScholarPubMed
Roseau, G., Palazzo, L., Dumontier, I.et al. Endoscopic ultrasonography in the evaluation of pediatric digestive disease: preliminary results. Endoscopy 1998; 30:477–481.CrossRefGoogle ScholarPubMed
Hirohashi, S., Hirohashi, S., Uchida, H.et al. Pancreatitis: evaluation with MR cholangio-pancreatography in children. Radiology 1997; 203:411–415.CrossRefGoogle Scholar
Barish, M. A., Yucel, E. K., & Ferrucci, J. T.Magnetic resonance cholangiopancreatography. N. Engl. J. Med. 1999; 341:258–264.CrossRefGoogle ScholarPubMed
Dugernier, T. L., Laterre, P. F., Wittebole, X.et al. Compartmentalization of the inflammatory response during acute pancreatitis. Am. J. Respir. Crit. Care. Med. 2003; 168:148–157.CrossRefGoogle ScholarPubMed
Pastor, C. M., Matthay, M. A., & Frossard, J. L.Pancreatitis-associated acute lung injury. New insight. Chest 2003; 124:2341–2351.CrossRefGoogle Scholar
Renner, I. G., Savage, W. T. III, Pantoja, J. L.et al. Death due to acute pancreatitis: a retrospective analysis of 405 autopsy cases. Dig. Dis. Sci. 1985; 30:1005–1018.CrossRefGoogle ScholarPubMed
Beaux, A. C., Palmer, K. R., & Carter, D. C.Factors influencing morbidity and mortality in acute pancreatitis; an analysis of 279 cases. Gut 1995; 37:121–126.CrossRefGoogle ScholarPubMed
Ranson, J. H., Rifkind, K. M., Roses, D. F.et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg. Gynecol. Obstet. 1974; 139:69–81.Google ScholarPubMed
Leteurtre, S., Martinot, A., Duhamel, A.et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003; 362:192–197.CrossRefGoogle ScholarPubMed
Balthazar, E. J.Complications of acute pancreatitis: clinical and CT evaluation. Radiol. Clin. North. Am. 2002; 40:1211–1227.CrossRefGoogle ScholarPubMed
Berghe, G., Wouters, P., Weekers, F.et al. Intensive insulin therapy in the critically ill patients. N. Engl. J. Med. 2001; 345:1359–1367.CrossRefGoogle ScholarPubMed
Olah, A., Pardavi, G., Belagyi, T.et al. Early nasojejunal feeding in acute pancreatitis is associated with a lower complication rate. Nutrition 2002; 18:259–262.CrossRefGoogle ScholarPubMed
Meier, R., Beglinger, C., Layer, P.et al. Consensus statement: ESPEN guidelines on nutrition in acute pancreatitis. Clin. Nutr. 2002; 21:173–183.CrossRefGoogle Scholar
Nathens, A. B., Curtis, J. R., Beale, R. J.et al. (2004). Management of the critically ill patient with severe acute pancreatitis. Crit. Care. Med., 32, 2524–2536.CrossRefGoogle ScholarPubMed
Andriulli, A., Leandro, G., Clemente, R.et al. Meta-analysis of somatostatin, octreotide and gabexate mesilate in the therapy of acute pancreatitis. Aliment. Pharmacol. Ther. 1998; 12:237–245.CrossRefGoogle ScholarPubMed
Messori, A., Rampazzo, R., Scroccaro, R.et al. Effectiveness of gabexate mesilate in acute pancreatitis. A metaanalysis. Dig. Dis. Sci. 1995; 40:734–738.CrossRefGoogle ScholarPubMed
Platell, C., Cooper, D., & Hall, J. C.A meta-analysis of peritoneal lavage for acute pancreatitis. J. Gastroenterol. Hepatol. 2001; 16:689–693.CrossRefGoogle ScholarPubMed
Johnson, C. D., Kingsnorth, A. N., Imrie, C. W.et al. Double blind, randomised, placebo controlled study of a platelet activating factor antagonist, lexipafant, in the treatment and prevention of organ failure in predicted severe acute pancreatitis. Gut 2001; 48:62–69.CrossRefGoogle ScholarPubMed
Shiratori, K., Takeuchi, T., Satake, K.et al. Clinical evaluation of oral administration of a cholecystokinin-A receptor antagonist (loxiglumide) to patients with acute, painful attacks of chronic pancreatitis: a multicenter dose-response study in Japan. Pancreas 2002; 25:e1–5.CrossRefGoogle ScholarPubMed
Mier, J., Luque-de Leon, E., Castillo, A.et al. Early versus late necrosectomy in severe necrotizing pancreatitis. Am. J. Surg. 1997; 173:71–5.CrossRefGoogle ScholarPubMed
Kelly, T. R. & Wagner, D. S.Gallstone pancreatitis: a prospective, randomized trial of the timing of surgery. Surgery 1988; 104:600–605.Google ScholarPubMed
Eghtesad, B., Reyes, J. D., Ashrafi, M.et al. Pancreatitis after liver transplantation in children: a single-center experience. Transplantation 2003; 75:190–193.CrossRefGoogle ScholarPubMed
Company, L., Saez, J., Martinez, J.et al. Factors predicting mortality in severe acute pancreatitis. Pancreatology 2003; 3:144–148.CrossRefGoogle ScholarPubMed
Tzovaras G, Parks RW, Diamond T, Rowlands BJ. Early and long-term results of surgery for severe necrotising pancreatitis. Dig. Surg. 2004; 21:41–47.
Neblett, W. W. & O'Neill, J. A.Surgical management of recurrent pancreatitis in children with pancreas divisum. Ann. Surg. 2000; 231:899–908.CrossRefGoogle ScholarPubMed
Shukri, N., Wasa, M., Hasegawa, T.et al. Diagnostic significance of pancreas divisum in early life. Eur. J. Pediatr. Surg. 2000; 10:12–16.CrossRefGoogle ScholarPubMed
Partington, P. F. & Rochelle, R. E.Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann. Surg. 1960; 152:1037–1042.CrossRefGoogle ScholarPubMed
DuBay, D., Sandler, A., Kimura, K., Bishop, W., Eimen, M., & Soper, R.The modified Puestow procedure for complicated hereditary pancreatitis in children. J. Pediatr. Surg. 2000; 35:343–348.CrossRefGoogle ScholarPubMed
Siddiqui, A. M., Shamberger, R. C., Filler, R. M.et al. Enteric duplications of the pancreatic head: definitive management by local resection. J. Pediatr. Surg. 1998; 33:1117–1120.CrossRefGoogle ScholarPubMed
Tissieres, P., Bugmann, P., Rimensberger, P. C.et al. Somatostatin in the treatment of pancreatic pseudocyst complicating acute pancreatitis in a child with liver transplantation. J. Pediatr. Gastroenterol. Nutr. 2000; 31:445–447.CrossRefGoogle Scholar
Kozarek, R. A., Ball, T. J., Patterson, D. J.et al. Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology 1991; 100:1362–1370.CrossRefGoogle ScholarPubMed
Buechler, M. W., Friess, H., Mueller, M. W.et al. Randomized trial of duodenum-preserving pancreatic head resection versus pyloric-preserving Whipple in chronic pancreatitis. Am. J. Surg. 1995; 169:65–69.CrossRefGoogle Scholar
Izbicki, J. P., Bloechle, C., Broering, D. C.et al. Extended drainage versus resection in surgery for chronic pancreatitis. A prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatoduodenectomy. Ann. Surg. 1998; 228:771–779.CrossRefGoogle Scholar
Pegoli Jr, W. Acute and chronic pancreatitis and pancreatic trauma. In Howard, E. R., Stringer, M. D. & Colombani, P. M.Surgery of the Liver, Bile Ducts and Pancreas in Children, 2nd edn. London: Arnold, 2002.Google Scholar
Sakorafas, G. H., Farnell, M. B., Farley, D. R.et al. Long-term results after surgery for chronic pancreatitis. Int. J. Pancreatol. 2000; 27:131–142.CrossRefGoogle ScholarPubMed
Braganza, J. M., Thomas, A., & Robinson, A.Antioxidants to treat chronic pancreatitis in childhood? Case report and possible implications for pathogenesis. Int. J. Pancreatol. 1988; 3:209–216.Google ScholarPubMed
Uden, S., Bilton, D., Nathan, L.et al. Antioxidant therapy for recurrent pancreatitis: placebo-controlled trial. Aliment. Pharmacol. Ther. 1990; 4:357–371.CrossRefGoogle ScholarPubMed
Sylvester, F. A., Shuckett, B., Cutz, E.et al. Management of fibrosing pancreatitis in children presenting with obstructive jaundice. Gut 1998; 43:715–720.CrossRefGoogle ScholarPubMed
EL-Matary, W., Casson, D., Hodges, S.et al.Successful conservative management of idiopathic fibrosing pancreatitis in children. Eur. J. Pediatr. 2006; March 22 E pub.CrossRefGoogle ScholarPubMed
Konzen, K. M., Perrault, J., Moir, C., & Zinsmeister, A. R.Long-term follow-up of young patients with chronic hereditary or idiopathic pancreatitis. Mayo. Clin. Proc. 1993; 68:449–453.CrossRefGoogle ScholarPubMed
Moir, C. R., Konzen, K. M., & Perrault, J.Surgical therapy and long-term follow-up of childhood hereditary pancreatitis. J. Pediatr. Surg. 1992; 27:282–286.CrossRefGoogle ScholarPubMed

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