Short and longterm prognosis

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Most cases of acute pancreatitis in childhood are isolated and uncomplicated, persisting for usually less than a week, and rarely progress to chronic pancreatitis. The chances of surviving a severe or complicated course of pancreatitis are directly related to the other organ systems involved. Associated complications can affect virtually all organ systems (Table 21.4).2-4,6,15,17-19,21,23,26,34,36,37,45,53,60-63

The primary morbidity and mortality arise from septic shock, renal failure, respiratory failure and inflammatory masses of the pancreas.

The APACHE-II and Ranson criteria, which have been developed to predict the outcome from acute pancreatitis in adults, are not as reliable in young children. Pediatric studies have shown a mortality rate of 5-17.5% from an initially mild presentation of acute pancreatitis to upwards of 80-100% from hemorrhagic pancreatitis or severe multisystem disorders. After a bout of necrotizing pancreatitis, exocrine and endocrine insufficiency are common. The degree of dysfunction correlates directly with the extent of parenchymal damage.

For patients with traumatic pancreatitis, in the absence of complete duct transection, nonoperative management is believed to be safe, and there are usually no long-term complications.63 Identification of those with hereditary pancreatitis is critical, as affected family members are at increased risk for pseudocysts, pancreatic adenocarcinomas, and exocrine and endocrine failure.

Table 21.4 Complications associated with pancreatitis (from references 2-4,6,15,17-19,21,23,26,34, 36,37,45,53,60-63)

Pancreatic

Systemic/metabolic

Abscess

Acidosis

Ascites

Atelectasis

Calculi

Adult respiratory distress syndrome

Carcinoma

Disseminated intravascular coagulation

Diabetes mellitus

Electrocardiographic changes

Duct strictures

Encephalopathy

Exocrine insufficiency

Fat emboli

Fibrosis

Fat necrosis

Fistula

Hyperglycemia

Necrosis

Hyperkalemia

Phlegmon

Hypertriglyceridemia

Pseudocyst

Hypoalbuminemia

Hypocalcemia

Gastrointestinal/hepatic

Hypotension

Biliary obstruction

Mediastinal abscess

Bowel infarction

Pericardial effusion

Gastritis

Pleural effusion

Gastrointestinal fistula

Pneumonitis

Hemorrhage

Psychosis

Hepatic vein thrombosis

Renal failure

Hepatorenal syndrome

Renal vessel thrombosis

Ileus

Respiratory failure

Jaundice

Sepsis

Peptic ulcer

Sudden death

Portal vein thrombosis

Thrombosis

Splenic vein varices

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