Acute pancreatitis in children: 10-year experience in a medical center

Background: Acute pancreatitis is uncommon in children compared with adults. The purpose of this study was to evaluate the etiologies, clinical presentations, image findings and outcome of children's acute pancreatitis. Methods: The medical records of children and adolescent patients admitted due to pancreatitis from July 1992 to July 2002 were reviewed. The diagnosis of pancreatitis was based on clinical symptoms, at least threefold elevation of serum pancreatic enzymes, and image findings. Results: This study comprised 75 patients with 96 episodes of pancreatitis. There were 36 males and 39 females, with a mean age of 10 years. The leading etiologies were idiopathic (26.7%), systemic diseases (22.7%), biliary tract disease (21.3%), and trauma (16%). Common initial manifestations included abdominal pain (93.8%), vomiting (64.2%), and fever (33.3%). The sensitivities of ultrasonography (US) and computed tomography (CT) in detecting pancreatitis were 57.3% and 74.4%, respectively. The morbidity included 6 pseudocysts and 16 repeated pancreatitis. Four pseudocysts were resulted from traumatic pancreatitis. Patients with hyperlipidemia and biliary tract disorder were more likely to have repeated attacks. Fifty-five (73.3%) patients recovered after conservative management, the remaining 20 (26.7%) patients needed surgical or other interventional treatment. The mortality rate was 5.3%. Three fatal cases (75%) had underlying medical diseases. Conclusions: The etiologies of acute pancreatitis are diverse. Abdominal CT is more sensitive than US in the diagnosis of pancreatitis. Pseudocysts are more likely to occur in patients with traumatic pancreatitis. Patients with hyperlipidemia are prone to recurrent pancreatitis. The prognosis of children's pancreatitis is good. Most patients with fatal outcome had coexistent medical diseases.