Clinical presentation, etiology and complications of acute pancreatitis in children: a retrospective, single-centre review

Childhood pancreatitisis a rare condition potentially associated with severe morbidity and mortality. The aim of the study was to determine the clinical features, etiology, and complications of pancreatitis in children. This descriptive case series was conducted in the Pediatric Department, Arcispedale Sant’Anna, Ferrara, from 1st January 2006 to 31st December 2016.The study included 16 children (7 boys), mean age 12,5 years (range 4 to 18 years), with acute pancreatitis. We analyzed a total of 22 episodes of acute pancreatitis (2 patients showed recurrence) The diagnosis of pancreatitis was based on the presence of at least two among the following diagnostic elements: (1) abdominal pain (2) amylase and/or lipase greather than 3 times the upper limit of normal (3) abnormal pancreatic diagnostic imaging. Results Less than a quarter of the cases of pancreatitis were due to an infection (6/22), other causes included systemic disease (Cystic Fibrosis 5 Kawasaki disease 1), toxins or drugs (4/22), and biliary tract disease (2). Four cases were idiopathic; no case of structural disease and trauma. Clinical features were abdominal pain (100%), nausea (73%), vomiting (55%) and fever (32%). All patients were managed conservatively with bowel rest, pain therapy, gastric decompression and intravenous fluid: total parenteral nutrition was administered only in three cases; 14/22 received antibiotic therapy, 3/22 gabexate mesyilate. One patient with common bile duct stone required therapeutic endoscopic retrograde cholangiopancreatography and one patient required exploratory laparoscopy. Morbidity included pseudocyst (1) and relapse (2). No case had a fatal outcome. Conclusions The incidence of acute pancreatitis is low in children. Pancreatitis can occur from a wide variety of causes and may result in severe complications. Early diagnosis, close monitoring and aggressive intervention are mandatory to reduce morbidity and mortality.