247 Etiology of acute pancreatitis in pediatric patients – a 7 year experience

Abstract

<h3></h3> The diagnosis of acute pancreatitis (AP) in children has been improving worldwide probably due to better awareness of physicians evaluating children with gastrointestinal symptoms. The common causes include anatomic abnormalities, drug toxicity, trauma, and systemic diseases, however, a significant proportion of cases are still being labeled as idiopathic. The aim of our study was to highlight the etiopathogenesis of acute pancreatitis in children diagnosed in a University Hospital Centre during a 7 year period. The charts of pediatric patients, from 2013.-2020. with at least one documented episode of acute pancreatitis requiring hospitalization, were reviewed retrospectively. Data included a clinical picture, laboratory findings (serum and urine amylase and lipase), abdominal ultrasound and MRCP findings as well as results of genetic analysis in a group of patients with previously unresolved etiology. We identified 33 patients with AP, 18 boys and 15 girls. The mean age at diagnosis was 12, 42 (range 3-18, median 14). The most frequent was idiopathic AP (n=19), followed by anatomical abnormalities (n=7). Drug-induced AP was seen in four patients due to valproate, enalapril and in two of azathioprine toxicity. Post-traumatic pancreatitis was diagnosed in one of our patients. Two of our youngest patients showed positive results in gene testing with both of them being heterozygous for serine protease inhibitor Kazal type 1 (SPINK1) mutation. Both of them developed acute recurrent pancreatitis later. In this retrospective analysis, the etiology of acute pancreatitis has similar distribution to previously reported causes in the paediatric literature. Genetic testing is a valuable tool in identifying the nature of previously designated idiopathic pancreatitis, especially in those with a more severe and recurrent presentation.