Pancreatitis is a terrible affliction whether acute, recurrent or chronic. While pediatric patients often have “mild” problems from acute pancreatitis, even in these cases the pain is usually severe and the treatment, which consists mainly of holding feedings and providing pain relief, does not impress anyone.
A few recent references do provide more data on several aspects of pancreatitis.
The first reference, J Pediatr 2013; 162: 788-92, provides data on the rare problem of acute necrotizing pancreatitis in children. This retrospective study encompassing 21 years identified seven children. CT scan showed necrosis of more than 30% and/or more than a 3 cm area in all of these patients. Etiologies included medications (L-asparaginase, Valproate, Minocycline), diabetes (n=1), and gallstones (n=1). No patients needed surgery or died. After discharge, 5 patients had complications which included pseudocysts, diabetes, and pancreatic exocrine insufficiency.
Key points:
- CT scan (with contrast) is useful in diagnosis and assessment of severity.
- Initial presentation is similar to cases of acute pancreatitis without necrosis. Long-term complications are increased.
The second reference: Gastroenterol 2013; 144; issue 6. The entire issue is devoted to pancreas issues. Pages 1272-81 review acute pancreatitis, pages 1282-91 review chronic pancreatitis, and pages 1292-1302 review genetic risk factors.
Page 1288 provides a suggested management algorithm for chronic pancreatitis:
Medical therapy recommendations include alcohol/smoking cessation, counsel regarding nutrition/vitamin D/calcium, consider analgesics (start with tramadol), consider adjuncts for pain (e.g.. neuron tin, SSRI, SSNRI, TCAs), assess exocrine and endocrine function (elastase and HgbA1C), use steroids if autoimmune pancreatitis.
If medical therapy ineffective, assessment of pancreatic duct is recommended. Based on this information, discussion of endoscopic and surgical treatment is outlined as well.
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