title: Clinical and pathologic characteristics of pancreatic necrosis in critically ill children.
abstract: BACKGROUND
  Pancreatic damage in critically ill patients is associated with the progressive failure of multiple organs, but little is known about its clinical characteristics. At present, no guidelines are available for the diagnosis and management of pancreatic damage. This study was undertaken to analyze the clinical and pathologic characteristics of pancreatic necrosis in critically ill children, and to find some biological markers of pancreatic damage or pancreatic necrosis.
  
  
  METHODS
  We retrospectively reviewed the clinical data, laboratory results, and autopsy findings of 25 children, who were admitted to Hunan Children's Hospital, China from 2003 to 2009, and died of multiple organ failure. The autopsy revealed pancreatic necrosis in 5 children, in whom sectional or gross autopsy was performed.
  
  
  RESULTS
  The 5 children had acute onset and a fever. Two children had abdominal pain and 2 had abdominal bulging, flatulence and gastrointestinal bleeding. Four children had abnormal liver function, characterized by decreased albumin and 3 children had elevated level of C-reactive protein (CRP). B-ultrasonography revealed abnormal acoustic image of the pancreas in all children, and autopsy confirmed pancreatic necrosis, which may be associated with the damage of the adrenal gland, liver, lung, heart, spleen, kidney, intestine, thymus, mediastinal and mesenteric lymph nodes and other organs. Children 1 and 2 died of acute hemorrhagic necrotizing pancreatitis (AHNP); children 3-5 died of multiple organ dysfunction syndrome (MODS) due to pancreatic necrosis.
  
  
  CONCLUSIONS
  Pancreatic damage or pancreatic necrosis in critically ill children is characterized by acute onset, severity, short course, multiple organ damage or failure. It may be asymptomatic in early stage, and easy to be ignored.
authors.affiliation: Emergency Center (Zhu YM, Xu ZY), Department of General Surgery (Zhou XY) and Department ofNeonatology (Gao XR), Hunan Children's Hospital, Changsha 410007, China; Department of Maternal and Children Health Care, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China(Liu F, Du YK).
authors.forename: Yi-Min
authors.initials: YM
authors.lastname: Zhu
authors.affiliation: Emergency Center (Zhu YM, Xu ZY), Department of General Surgery (Zhou XY) and Department ofNeonatology (Gao XR), Hunan Children's Hospital, Changsha 410007, China; Department of Maternal and Children Health Care, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China(Liu F, Du YK).
authors.forename: Fang
authors.initials: F
authors.lastname: Liu
authors.affiliation: Emergency Center (Zhu YM, Xu ZY), Department of General Surgery (Zhou XY) and Department ofNeonatology (Gao XR), Hunan Children's Hospital, Changsha 410007, China; Department of Maternal and Children Health Care, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China(Liu F, Du YK).
authors.forename: Xiao-Yu
authors.initials: XY
authors.lastname: Zhou
authors.affiliation: Emergency Center (Zhu YM, Xu ZY), Department of General Surgery (Zhou XY) and Department ofNeonatology (Gao XR), Hunan Children's Hospital, Changsha 410007, China; Department of Maternal and Children Health Care, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China(Liu F, Du YK).
authors.forename: Xi-Rong
authors.initials: XR
authors.lastname: Gao
authors.affiliation: Emergency Center (Zhu YM, Xu ZY), Department of General Surgery (Zhou XY) and Department ofNeonatology (Gao XR), Hunan Children's Hospital, Changsha 410007, China; Department of Maternal and Children Health Care, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China(Liu F, Du YK).
authors.forename: Zhi-Yue
authors.initials: ZY
authors.lastname: Xu
authors.affiliation: Emergency Center (Zhu YM, Xu ZY), Department of General Surgery (Zhou XY) and Department ofNeonatology (Gao XR), Hunan Children's Hospital, Changsha 410007, China; Department of Maternal and Children Health Care, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China(Liu F, Du YK).
authors.forename: Yu-Kai
authors.initials: YK
authors.lastname: Du
keywords: Autopsy; Critically ill children; Pancreatic damage; Pancreatic necrosis