Acute pancreatitis in childhood.
OBJECTIVE
to evaluate etiological agents involved in acute pancreatitis in children, as well as clinical, laboratory and radiological findings and the illness clinical course.


METHODS
we reviewed the cases of acute pancreatitis diagnosed over the last 15 years. The criteria used for cases to be included were acute abdominal pain, elevated serum amylase levels and/or ultrasound abnormalities in the pancreatic area in conscious patients, and the last two criteria in unconscious patients.


RESULTS
thirty-one children were included (average age 7.9 years, range 2-15; 55% males). Infection and gallstones were the most common causes (19 and 16 %, respectively). In all, 9.7% of cases were drug-related (valproic acid, L-asparaginase, azathioprine combined with high doses of methylprednisolone); 6.5% were traumatic in origin and another 6.5% was due to systemic diseases. In 35.5 % no cause was found (idiopathic). The most frequent symptoms were abdominal pain (90%) and emesis (38%). Amylase serum levels were elevated in all patients. Abdominal ultrasound scans were abnormal in 64%, with an increase in the pancreatic area in 48% and hypoechogenicity in 51%. Seven cases required surgical treatment (22%). Seven children had acute pancreatitis, and three of them died as a result of shock unrelated to pancreatitis. Relapse of disease occurred in 19% of patients.


CONCLUSIONS
acute pancreatitis should always be considered in children with abdominal pain. There are a wide variety of etiological factors and in a high percentage of patients no underlying cause is found. Prognosis is variable owing to the heterogeneity of the clinical course of this illness in children.
Alvarez Calatayud
G
G
Section of Pediatric Gastroenterology. San Rafael Hospital. Madrid. Spain.
Bermejo
F
F
Morales
J L
JL
Claver
E
E
Huber
L B
LB
Abunaji
J
J
Cañete
A
A
Boixeda
D
D
D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D000367:Age Factors; D000681:Amylases / Q000097:blood; D002648:Child; D002675:Child, Preschool; D004796:Clinical Enzyme Tests; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D008297:Male; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000601:surgery; D010195:Pancreatitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery / Q000628:therapy; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012737:Sex Factors; D014463:Ultrasonography; D014839:Vomiting / Q000209:etiology
D000681:Amylases