Multidisciplinary management of surgical disorders of the pancreas in childhood.
OBJECTIVE
To describe the frequency and range of pancreatic disorders in children requiring surgical intervention and to highlight the importance of multidisciplinary management.


METHODS
An audit of all children under 17 years of age referred with surgical disorders of the pancreas or pancreatitis to a regional pediatric gastroenterology unit in the United Kingdom during a 10-year period. A retrospective chart review of clinical features, pathology and outcome was undertaken.


RESULTS
Surgical intervention was required for the following pancreatic disorders: persistent hyperinsulinemic hypoglycemia of infancy (n = 4), pancreatic tumors (n = 5), pancreaticobiliary malunion (n = 12), pancreatic trauma (n = 6) and pancreatitis (n = 10). The indications for surgery in acute pancreatitis were a persistent pseudocyst (n = 1) and treatment of an underlying cause of pancreatitis (n = 4); in chronic pancreatitis, surgery was used to treat symptomatic pancreatic duct strictures (n = 4). One child died of a progressive lymphoma but all others who underwent surgery are alive and well. All 33 children with acute pancreatitis, including four with pancreatic necrosis, survived.


CONCLUSIONS
Surgery for pancreatic disorders in children is rarely required but may be necessary a) for definitive management of primary pancreatic pathology, b) to treat sequelae of acute or chronic pancreatitis and c) to treat an underlying cause of pancreatitis. There is a broad spectrum of potential pathologies. These patients are best managed by a multidisciplinary team approach.
Stringer
Mark D
MD
Children's Liver and Gastrointestinal Unit and Department of Paediatric Gastroenterology, Leeds Teaching Hospitals NHS Trust, Leeds, UK. mdstringer@dial.pipex.com
Davison
Suzanne M
SM
McClean
Paddy
P
Rajwal
Sanjay
S
Puntis
John W L
JW
Sheridan
Maria
M
Ramsden
William
W
Woodley
Helen
H
D000208:Acute Disease; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D044903:Congenital Hyperinsulinism / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010179:Pancreas / Q000293:injuries / Q000473:pathology / Q000601:surgery; D010180:Pancreatectomy; D010181:Pancreatic Cyst / Q000473:pathology / Q000601:surgery; D010182:Pancreatic Diseases / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D010195:Pancreatitis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D006113:United Kingdom