The clinician needs to have a high index of suspicion for pancreatitis in the child who presents with the non-specific but common symptoms of nausea, vomiting and abdominal pain. A thorough history that emphasizes recent infections, medications, trauma and any underlying medical condition may make the diagnosis clearer. The traditional use of enzyme testing alone (serum amylase and lipase) for the diagnosis of both acute and chronic pancreatitis may not be adequate, since the clinical specificity remains suboptimal.
Unlike pancreatitis in adults, in which the majority of cases are due to either gallstone disease or alcoholism, this disease in childhood can be from a variety of disparate causes. No identifying factor is present in up to 25% of cases. Common known etiologies include infection, trauma, medications, abnormal anatomy and hereditary or systemic diseases. A family history of pancreatitis, espe cially occurring at a young age, should prompt the physician to look for evidence of anatomic abnormalities or inherited biochemical defects.
Ultrasound remains the initial radiographic study of choice in acute pancreatitis in childhood, to screen for infection, cholelithiasis, congenital abnormalities and biliary ductal dilatation. If the course of the pancreatitis is complicated or recurrent, further detailed imaging of the biliary system should be performed with ERCP, MRCP or percutaneous or intraoperative cholangiogram.
Treatment of acute, uncomplicated pancreatitis in the pediatric population is basically supportive, and most children will recover without sequelae. Complications, when they occur, can involve every major organ system and be life-threatening. Children with severe or complicated pancreatitis should be managed at a center with expertise in pediatric biliary surgery and non-operative radiological and endoscopic interventions.
Karne S, Gorelick FS. Etiopathogenesis of acute pancreatitis. Surg Clin North Am 1999; 79: 699-710. Lerner A. Acute pancreatitis in children and adolescents. In Lebenthal E, ed. Gastroenterology and Nutrition in Infancy, 2nd edn. New York: Raven Press, 1989: 897-906.
Robertson MA, Durie PR. Pancreatitis. In Walker WA, Durie PR, Hamilton JS, Walker-Smith JA, Watkins JB, eds. Pediatric Gastrointestinal Disease, 2nd edn. St Louis: Mosby, 1996: 1436-1465. Roy CC, Silverman A, Alagille D. Pancreatitis and pancreatic tumors. In Roy CC, Silverman A, Alagille D, eds. Pediatric Clinical Gastroenterology, 4th edn. St. Louis: Mosby, 1995: 986-1004.
Tietz NW. Support of the diagnosis of pancreatitis by enzyme tests - old problems, new techniques. Clin Chim Acta 1997; 257: 85-98.
Weizman Z. Acute pancreatitis. In Wyllie R, Hyams JS, eds. Pediatric Gastrointestinal Disease. Philadelphia: WB Saunders, 1993: 873-879.
Durie PR. Pancreatitis and mutations of the cystic fibrosis gene. N Engl J Med 1998; 339: 687-688. Werlin SL, Casper J, Antonson D et al. Pancreatitis associated with bone marrow transplantation in children. Bone Marrow Transplant 1992; 10: 65-69. 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.
Collins JE, Brenton DP. Pancreatitis and homocystinuria.
J Inherit Metab Dis 1990; 13: 232-233.
Kahler SG, Sherwood G, Woolf D et al. Pancreatitis in patients with organic acidemias. J Pediatr 1994; 124:
Lévy P, Menzelxhiu A, Paillot B et al. Abdominal radiotherapy is a cause for chronic pancreatitis. Gastroenterology 1993; 105: 905-909. Keljo DJ, Sugerman KS. Pancreatitis in patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr 1997; 25: 108-112.
See Y, Martin K, Rooney M et al. Severe juvenile dermatomyositis complicated by pancreatitis. Br J Rheumatol 1997; 36: 912-916.
Guelrud M, Morera C, Rodriguez M et al. Sphincter of Oddi dysfunction in children with recurrent pancreatitis and anomalous pancreaticobiliary union: an etiologic concept. Gastrointest Endosc 1999; 50: 194-199. Mattioli G, Buffa P, Pesce F et al. Pancreatitis caused by duodenal duplication. J Pediatr Surg 1999; 34: 645-648. Dassopoulos T, Ehrenpreis ED. Acute pancreatitis in human immunodeficiency virus-infected patients: a review. Am J Med 1999; 107: 78-84. Kamelmaz I, Elitsur Y. Pancreas divisum - the role of ERCP in children. W VMed J 1999; 95: 14-16. Lerner A, Branski D, Lebenthal E. Pancreatic diseases in children. Pediatr Clin North Am 1996; 43: 125-156. Carroccio A, Fontana M, Spagnuolo MI et al. Serum pancreatic enzymes in human immunodeficiency virus-
infected children. A collaborative study of the Italian Society of Pediatric Gastroenterology and Hepatology. Scand J Gastroenterol 1998; 33: 998-1001. Brivet FG, Naneau SH, Lemaigre GF et al. Pancreatic lesions in HIV-infected patients. Ballieres Clin Endocrinol Metab 1994; 8: 859-877. Kahn E, Anderson VM, Greco A et al. Pancreatic disorders in pediatric acquired immune deficiency syndrome. Hum Pathol 1995; 26: 765-770. Aboulafia DM. Acute pancreatitis: a fatal complication of AIDS therapy. J Clin Gastroenterol 1997; 25: 640-645. Friedman SL. Kaposi's sarcoma and lymphoma of the gut in AIDS. Ballieres Clin Gastroenterol 1990; 4: 455-475.
Welsh MJ, Tsui LC, Boat TF et al. Cystic fibrosis. In Scriver CR, Beaudet AL, Sly WS, Valle D, eds. The Metabolic and Molecular Basis of Inherited Disease. New York: McGraw-Hill, 1995: 3799-3876. Dodge JA. Paediatric and hereditary aspects of chronic pancreatitis. Digestion 1998; 59 (Suppl 4): 49-59. Uomo G, Manes G, Rabitti PR. Role of hereditary pancreatitis and CFTR gene mutations in the aetiology of acute relapsing pancreatitis of unknown origin. How are they important? J Pancreas (Online) 2001; 2: 368-372.
Rosenstein MG, Cutting GR. The diagnosis of cystic fibrosis: a consensus statement. J Pediatr 1998; 132: 589-595.
Cohn JA, Friedman KJ, Noone PG et al. Relation between mutations of the cystic fibrosis gene and idiopathic pancreatitis. N Engl J Med 1998; 339: 653-658.
Cohn JA, Jowell PS. Are mutations in the cystic fibrosis gene important in chronic pancreatitis? Surg Clin North Am 1999; 79: 723-731.
Sharer N, Schwarz M, Malone G et al. Mutations of the cystic fibrosis gene in patients with chronic pancreatitis. N Engl J Med 1998; 339: 645-652. Elitsur Y, Chertow BC, Jewell RD et al. Identification of a hereditary pancreatitis mutation in four West Virginia families. Pediatr Res 1998; 44: 927-930. Whitcomb DC, Gorry MC, Preston RA et al. A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology 1996; 110: 1975-1980. Gates LK, Ulrich CD II, Whitcomb DC. Hereditary pancreatitis. Surg Clin North Am 1999; 79: 711-722. Whitcomb DC. Hereditary pancreatitis: a model for understanding the genetic basis of acute and chronic pancreatitis. Pancreatology 2001; 1: 565-570. Perrault J. Hereditary pancreatitis. Gastroenterol Clin North Am 1994; 23: 743-752. Uretsky G, Goldschmiedt M, James K, Childhood pancreatitis. Am Fam Physician 1999; 59: 2507-2512. Pfützer RH, Whitcomb DC. SPINK1 mutations are associated with multiple phenotypes. Pancreatology 2001; 1: 457-460.
Pfützer RH, Barmada MM, Brunskill APJ et al. SPINK1/PSTI polymorphisms act as disease modifiers in familial and idiopathic chronic pancreatitis. Gastroenterology 2000; 119: 615-623. Chen JM, Mercier B, Audrezet MP et al. Mutational analysis of the human pancreatic secretory trypsin inhibitor (PSTI) gene in hereditary and sporadic chronic pancreatitis (letter). J Med Genet 2000; 37: 67-69. Rossi L, Pfützer RH, Parvin S et al. SPINK1/PSTI mutations are associated with tropical pancreatitis in Bangladesh: a preliminary report. Pancreatology 2001; 1: 242-245.
Teich N, Ockenga J, Hoffmeister A et al. Chronic pancreatitis associated with an activation peptide mutation that facilitates trypsin activation. Gastroenterology 2000; 119: 461-465.
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