In a retrospective study of patients 18 years of age and younger over a 28-year period, 48 children had
pancreatitis. Epigastric
pain,
nausea, and
emesis were present in 90%.
Hyperamylasemia was present in 34 children; elevated
amylase/
creatinine clearance ratio was helpful in diagnosing ten others. In four children,
pancreatitis was diagnosed at
laparotomy. Etiology of the
pancreatitis was idiopathic in 16,
drug-induced in 12, all of whom had received
corticosteroids. Nine developed
pancreatitis after blunt
trauma; seven had obstruction of the pancreaticobiliary drainage system. Two children developed
pancreatitis in association with
sepsis, and two had recurrent
hereditary pancreatitis. Thirty of the 48 patients were managed nonoperatively while operations were required in 18. Seven had drainage of
pancreatic pseudocysts, four had a
pancreatectomy, and four underwent
laparotomy with
debridement and drainage of necrotic pancreas. Bilioenteric bypass procedures were performed to prevent recurrent
pancreatitis in three patients; while duodenojenjunostomy sphincteroplasty and
cholecystectomy were performed in one child each. Cure was achieved in 38 of 48 children treated for
pancreatitis and its complications; each subsequently grew and developed normally.
Hemorrhagic pancreatitis occurred in seven children, six of whom died. Seven deaths occurred, all in the medically treated group. Fifteen of the 18 children treated operatively did well in long-term follow-up. Although rare,
pancreatitis is a serious cause of
abdominal pain in childhood; almost half of the children will benefit from operation.(ABSTRACT TRUNCATED AT 250 WORDS)