Abstract

Aim: The reasons for pediatric pancreatitis are different from those that effect adults. While biliary stones and alcohol intake are the two major etiological reasons that effect adults, factors such as trauma, biliary system disease, pharmacological agents, heredity, infections and congenital anomalies cause childhood pancreatitis. Further, 20% of pediatric cases are idiopathic pancreatitis with no obvious reason. Our purpose in this study was to reveal the etiologies of pancreatitic cases followed in our clinic, and review diagnostic modalities and treatment strategies.

Method: A total of 17 (n:17) cases of pancreatitis aged between 4 and 17, hospitalized and treated in our clinic between the years 1994 and 2009 were reviewed retrospectively. The patients were assessed with regard to age, gender, etiological factors, diagnosis and treatment modalities.

Results: The mean age of our cases was 10,8 (4-17) years. Of these, 8 were male and 9 female. The serum amylase level of each patient was identified. Except one, all patients had high serum amylase levels. The etiologies of pancreatitis among our patients were as follows: Familial hypertriglyceridemia (n:3) (17,6 %), cholelitiasis (n:3) (17,6 %), use of anti-epileptic drugs (n:2) (11,8 %), trauma (n:4) (23,5 %), parotid infection (n:1) (5,9 %), and Oddi sphincter dysfunction (n:1) (5,9 %). No underlying factor was found in 3 of our patients, who were consequently considered idiopathic (17,6 %). Two cases were treated by using endoscopic retrograde cholangiopancreatography (ERCP). While one underwent sphincterotomy and dilatation, a stent was placed in the other with ERCP (11,8 %). Distal pancreatectomy was used in one patient whose pancreatitis was due to trauma (5,9 %). The remaining fourteen patients were treated with conservative management (82,4 %). On follow-up, pseudocyst developed in five patients. One pseudocyst regressed spontaneously, while two were treated with percutaneous drainage. Jejunal resection and duodenojejunal anastomosis and cystojejunostomy were performed for one of the remaining pseudocysts for intestinal continuity and drainage. Two cases with cholelitiasis underwent elective cholecystectomy.

Conclusion: Recently, emergency laparotomy is no longer the preferred treatment for pediatric pancreatitis patients. Instead, conservative management should first be attempted, followed by endoscopic procedures in case of complications, and surgical treatment only if necessary.