Traumatic pancreatitis: long-term review of initial non-operative management in children

OBJECTIVE: To assess the safety and long-term efficacy of an initial non-operative approach to the management of pancreatic trauma in children. METHODOLOGY: Retrospective case-note review of children admitted to our institution with the diagnosis of pancreatic trauma over a 10-year period from 1985 to 1994 inclusive. RESULTS: Fourteen children were identified with a diagnosis of traumatic pancreatitis. Eleven of the injuries were secondary to motor vehicle accidents or trauma from a bicycle handlebar. In seven patients there were associated intra-abdominal injuries and in eight patients the traumatic pancreatitis was complicated by development of a pseudocyst. Three pseudocysts settled without intervention, two resolved with percutaneous external drainage and the remaining three required open surgery. The mean in-patient stay was 21.2 days. The average length of follow-up was 7.7 years with no observed long-term complications. CONCLUSIONS: Non-operative management of traumatic pancreatitis in the absence of complete duct transection is safe in children and does not appear to be associated with adverse sequelae.     

Hereditary pancreatitis presenting in childhood: Case report with family studies

Abstract A 12-year-old boy presented with recurrent abdominal pain and failure to thrive and was shown to have chronic calcific pancreatitis. Investigations failed to show any of the demonstratble causes of pancreatitis, but on family study four close paternal relatives were found to have had chronic pancreatitis, three with radiological calcification. No definable cause for pancreatitis had been determined in any of these relatives.     

Recurrent pancreatitis after renal transplantation in a child

Abstract:  A five-yr-old girl, who was a renal transplant recipient, presented with nausea, vomiting, epigastric discomfort, papules, and vesicles on her body. She was diagnosed with acute pancreatitis and varicella zoster infection because her serum amylase and lipase levels were positive. Fourteen months later, she was readmitted with nausea, vomiting, and epigastric pain similar to the previous symptoms and was diagnosed with acute pancreatitis. This case report indicates that acute pancreatitis can be one of a number of complications following pediatric renal transplantation and can recur because of various causes.     

Acute pancreatitis associated with varicella infection in an immunocompetent child

Acute pancreatitis associated with varicella-zoster infection is a rare event, particularly in immunocompetent children. We report on a case of acute pancreatitis in a 6-year old girl presenting with acute abdominal pain less than 72 hours after the onset of a typical vesicular rash. The diagnosis was confirmed through hyperamylasaemia, ultrasonographic findings of oedematous pancreatitis and acute seroconversion to varicella-zoster virus, after excluding more common causes of acute pancreatitis. Conservative treatment was initiated, with complete resolution of symptoms and absence of local or systemic complications on follow up. A review of the literature revealed only three previously reported cases, with very different outcomes, highlighting the need to consider this potentially fatal complication in every child presenting with acute abdominal pain during the course of varicella disease.     

慢性胰腺炎3例临床及内镜诊治分析

目的 探讨由基因或结构异常所致慢性胰腺炎患儿的临床特点,及其经内镜逆行胰胆管造影术(ERCP)诊治的临床疗效.方法 回顾分析2020年7-10月采用ERCP治疗的3例慢性胰腺炎患儿的临床资料.结果 3例慢性胰腺炎患儿,2例男性、1例女性,年龄为11岁1例,12岁2例,主要临床症状均为慢性腹痛,无胰腺内外分泌功能不全的表...     

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??Abstract??The incidence of pancreatitis in childhood has been rising in recent years. Either acute pancreatitis or chronic?? a main symptom is abdominal pain. Early diagnosis of these two diseases relies on the alert in a pediatrist’s mind and choosing lab and imaging examinations correctly. Otherwise?? missed or delayed diagnosis often occurs easily. Although conservative treatments have been the most important therapeutic options?? multiple disciplines of treatment can be attractive and improve prognosis of patients.     

Usefulness of pancreatic ultrasonography in the diagnosis of Shwachman-Bodian-Diamond syndrome

AIM: To evaluate the usefulness of pancreatic ultrasonography in diagnosing Shwachman-Bodian-Diamond syndrome (SBDS). METHODS: Diagnostic methods in two infants with SBDS were retrospectively reviewed. RESULTS: Patient 1 first presented with hepatic steatosis in the early infantile period, and later developed myelodysplastic syndrome. Patient 2 presented with frequent infections and elevated liver function tests without any haematological alterations. Both patients were considered to have impaired exocrine pancreatic function. Abdominal ultrasonography (US) obtained at 9 mo for patient 1 and at 10 mo for patient 2 showed diffuse high echogenicity, which raised suspicions of SBDS. SBDS gene analysis confirmed SBDS in both patients.CONCLUSION: Pancreatic US is sensitive in detecting pathological change in SBDS patients. It should be applied to the diagnostic approach for patients who show only minor signs of SBDS.     

Severe acute pancreatitis in a child with phenylketonuria

We report for the first time severe acute pancreatitis in a child treated for phenylketonuria (PKU) discovered on neonatal screening. This 2-year-old boy was first hospitalized for bilious vomiting and moderate back pain. Laboratory values included a lipase level of 1.142 U/L, a phenylalanine level of 10 mg/dL, and computed tomography revealed Balthazar grade E pancreatitis. Continuous enteral feeding was started on the 3rd day after admission. We observed clinical and biological improvement. Etiologic investigations for pancreatitis returned negative. Despite the severity of the pancreatitis, we did not observe decompensation of the metabolic disease. Specific nutritional management was necessary.     

Hereditary pancreatitis in a family of Aboriginal descent

Hereditary pancreatitis is an autosomal dominant condition characterized by recurrent episodes of acute pancreatitis, usually starting in childhood. We present a family who was ascertained when an 11-year-old girl presented with an episode of acute pancreatitis. Her father and other family members had also had recurrent bouts of acute pancreatitis. Genetic testing revealed a pathogenic mutation in the cationic trypsinogen gene in the proband, her father and her paternal grandmother. As far as we are aware, this is the first Aboriginal kindred with mutation-proven hereditary pancreatitis. Hereditary pancreatitis is an important differential diagnosis to consider in a patient with recurrent episodes of acute pancreatitis with no obvious precipitating cause. This family is of Aboriginal descent and the implications of the family's background are also discussed when considering the aetiology of the condition. We emphasize the need to ascertain a full family history from patients with a history of repeated episodes of acute pancreatitis and also emphasize the need to avoid ethnic stereotypes when assessing patients.     

Hereditary pancreatitis: An updated review in pediatrics

Hereditary Pancreatitis (HP) has emerged as a significant cause of acute, acute recurrent and chronic pancreatitis in the pediatric population. Given that it presents similarly to other causes of pancreatitis, a positive family history and/or isolation of a gene mutation are vital in its designation. Inheritance patterns remain complex, but mutations involving the PRSS1, SPINK1, CFTR and CTRC genes are commonly implicated. Since being first described in 1952, dozens of genetic alterations that modify the action of pancreatic enzymes have been identified. Among children, these variants have been isolated in more than 50% of patients with chronic pancreatitis. Recent research has noted that such mutations in PRSS1, SPINK1 and CFTR genes are also associated with a faster progression from acute pancreatitis to chronic pancreatitis. Patients with HP are at increased risk of developing diabetes mellitus, exocrine pancreatic insufficiency, and pancreatic adenocarcinoma. Management follows a multi-disciplinary approach with avoidance of triggers, surveillance of associated conditions, treatment of pancreatic insufficiency and use of endoscopic and surgical interventions for complications. With significant sequela, morbidity and a progressive nature, a thorough understanding of the etiology, pathophysiologic mechanisms, diagnostic evaluation, current management strategies and future research considerations for this evolving disease entity in pediatrics is warranted.