Cause Of Pancreatitis In Children Research Articles

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Purpose - to analyze modern approaches to understanding classification, etiopathogenesis, principles of diagnosis of pancreatitis in children. The pancreas has an important role in the processes of adequate digestion and assimilation of nutrients, as it ensures the fermentation of proteins, fats, and carbohydrates. The problem of pancreatitis in pediatrics worries not only domestic specialists, it is extremely important for study by the medical community in the world. Experts of the European Pancreatic Club focused on the fact that the incidence of acute pancreatitis has increased over the last 10-15 years and is 3.6-13.3 cases per 100,000 children. Taking into account such statistics, acute pancreatitis leaves the rubric of rare diseases, as it approaches the frequency in adults. It is important to understand the leading etiological factors of pancreatitis in childhood, as they are not identical to those in adult patients. However, the etiological factors in children are not of the same type according to the data of various studies. For example, according to the results of a twelve-year research in the USA, the dominant causes of pancreatitis in children were biliary tract problems (36.2%) and drug use (25.6%). Among sick children living in India, the causes were mostly injuries (21%) and biliary pathology. One of the latest data obtained in the study of children in the USA shows the structure of etiological factors: idiopathic (31%) and the influence of medications (23%). Analysis of the clinical course of the first episode of pancreatitis in children revealed that age, male gender, pancreatic necrosis and a higher body mass index were associated with the formation of a recurrent course. However, it is necessary to take into account possible anatomical anomalies of the biliary tract, hyperlipidemia and genetic factors. Modern guidelines and clinical recommendations for the diagnosis of pancreatitis in children mostly coincide and suggest taking into account the existing clinical symptoms and their consistency with the data of additional research methods. No conflict of interests was declared by the author.

Hypertriglyceridemia Induced Acute Pancreatitis Caused by a Novel LIPC Gene Variant in a Pediatric Patient

Hypertriglyceridemia induced acute pancreatitis is a rare cause of pancreatitis in children. Hepatic lipase deficiency is an extremely rare cause of hypertriglyceridemia, reported in only a few families to date. Hepatic lipase is the enzyme involved in the hydrolysis of triglycerides and phospholipids in remnants of triglyceride-rich lipoproteins that have a role in the conversion of very low density lipoprotein remnants to low density lipoproteins. Hepatic lipase deficiency is inherited in an autosomal recessive pattern. Detection of heterozygous carriers of hepatic lipase mutations remains accidental at the population level, as affected persons with a heterozygous state of hepatic lipase mutation do not display specific lipoprotein abnormalities and also patients with complete hepatic lipase deficiency have inconstant phenotype. The proximal promoter of the LIPC gene consists of four polymorphic sites in complete linkage disequilibrium. Five missense mutations in encoding exons have been described and proved to be responsible for hepatic lipase deficiency to date: S267F, T383M, L334F, A174T, and R186H, affecting the activity and secretion of hepatic lipase. We identified a primary disorder of the lipid metabolism as the cause of the acute episode of pancreatitis in a four years old patient, consisting of hepatic lipase deficiency caused by a novel genetic variant of the LIPC gene, a gross deletion of the genomic region encompassing exon 1. This variant was not previously described in the literature in persons with LIPC-related disorders and its significance is currently uncertain, but in the presented clinical and paraclinical context, it has the characteristics of a pathological variant inducing a hepatic lipase deficiency phenotype.

Ayurvedic Management of Chronic Pancreatitis in Adolescent Girl: A Case Report

Background- Chronic pancreatitis is the primary life-threatening nutritional & metabolic condition of gastrointestinal system that becomes a significant threat to the children's growth and induces educational loss due to recurrent hospitalization. Its mortality rate in childhood is up to 10 %. Malnutrition is one of the primary causes of pancreatitis in children. Modern science provides various types of medical and surgical therapies for Chronic pancreatitis, but it is realized that more research is needed for its management satisfactorily.
 Aim - To study the efficacy of Ayurvedic management of chronic pancreatitis induced due to Malnutrition in an adolescent girl.
 Material & Methods- It is a single case study of 12 years old teenage girl who was presented herself predominantly with pain in the epi-gastric region (recurrent attacks-especially after intake of the fatty or heavy meal), tenderness in the epi-gastric area, loss of appetite, fever on and off, general malaise, loss of weight, constipation (intermittent), anxious & uncomfortable mental irritation since one & half month. After taking conservative treatment from modern science for one & a half months, she did not get satisfactory relief & therefore; she was advised to under ERCP. However, the patient & her relative was not willing to undergo the same, that’s they approached Panchakarma OPD. After examination, she was advised for Shodhana(Panchtikta & Guduchyadi Niruha Vasti) & Shaman Chikitsa(Amruttotara Kashayam, Arogyavardhini Vati, Kumariasava; Dhanvantara Kashayam, Avipattikar Churna), Panchatikta Ghrita with Vasant Kusumakar Rasa- 10tab+Guduchi Satva- 20gm + Shatavari Churna- 15gm+ Ashwagandha Choorna-15 gm with honey.
 Observation & Results- After 16 months of regular treatment, the patient has become entirely symptom-free & to date, there was no need for hospitalization. There was no educational loss due to ill-health.
 Discussion:-Utilizing the basic concepts of Ayurveda(Nidanpanchaka), Jirna Jwarahara, Yakrutottejak, Pramehaghna, or pancreatic-protective, Mrudu Virechak, Bruhana (Shamana & Bruhana Snehapana), Rasayana Chikitsa was planned in this case which showed the promising result.
 Conclusion- Ayurvedic management with Shodhana & Shamana Chikitsa based on the fundamentals of Ayurveda is effective in Chronic pancreatitis induced due to Malnutrition in children, which may become a ray of hope for pediatric patients.

Post Covid Acute Necrotizing Pancreatitis

The Coronavirus Pandemic began in China in December 2019. In a short time, this pandemic spread globally. World has been challenged by SARS COV-2, a new virus causing pneumonia and acute respiratory distress syndrome. There is lack of literature implicating COVID-19 in Pancreatitis, yet virus is generally understood to be a cause of pancreatitis in children. We present a case of previously well 12-year-old girl who presented to emergency department with a chief complain of abdominal pain, anorexia and bilious vomiting. She was diagnosed with acute pancreatitis with an abnormal lipase, ultrasound and computed tomography and was found to be COVID-19 positive by polymerase chain reaction. Our case suggest that in current pandemic, consideration for SARS COV2 testing in children with gastrointestinal symptoms and pancreatitis may be considered. Additionally, this case highlights the need for appropriate personal protective equipment for providers, even when COVID is not initially on the differential.

Hypertriglyceridemia Induced Pancreatitis: Inpatient Management at a Single Pediatric Institution.

Hypertriglyceridemia-induced pancreatitis is an important cause of acute pancreatitis (AP) in children, which lacks established guidelines. The aim of this study was to review management approaches at a single pediatric center. This retrospective study included all inpatients younger than 21 years with AP and triglycerides (TG) of 1000 mg/dL or greater. A linear mixed effect model was used to calculate drop in TGs. The patient's diet, intravenous fluid (IVF) rate, insulin, and plasmapheresis were included in the model. Seventeen admissions were identified among 8 patients, average age 15 years (range, 6-19 years). Fifty percent had recurrent AP and 29% of admissions had complications including 1 death. The population was primarily female (75%), white (75%), and overweight, and 63% had diabetes. The median stay was 5.4 days. There were 14 approaches used with variations in IVF rates, insulin, plasmapheresis, and nill per os (NPO) versus feeds. Variables that reduced TG's were NPO, higher IVF rates, plasmapheresis, and insulin (P < 0.05). Importantly, NPO reduced TGs faster than those who started early nutrition. Hypertriglyceridemia is an important cause of pancreatitis in children. This study shares a management algorithm from a single institution. Larger studies are needed for more evidence-based guidelines.

Assessment of Subclinical Pancreatitis in Epileptic Children With Different Treatment Modalities.

Acute pancreatitis differ in pediatrics and adults. Drug-induced pancreatitis is one of the common causes of pancreatitis in children. This case–control study aimed to assess subclinical pancreatitis in patients with epilepsy treated with different drug regimens. Eighty known patients with epilepsy were enrolled. Forty patients were treated with monotherapy (group I) and 40 were treated with multitherapy (group II) regimens. Twenty age- and sex-matched healthy children were enrolled as control (group III). Serum lipase and amylase were assayed in all included children. Significant differences were found between groups I and III and between groups II and III regarding serum amylase and lipase (P < .001 for all). Significant difference were found between groups I and II (P = .024) and between groups II and III (P = .01) regarding pancreatic duct and body diameters. Significant difference were found between patients with controlled and uncontrolled fits regarding serum amylase (P = .008). In conclusion, subclinical pancreatitis can complicate the treatment with different antiepileptic regimens.

Characteristics of Pediatric Pancreatitis on Magnetic Resonance Cholangiopancreatography.

Pediatric pancreatitis is not uncommon and results in considerable morbidity and mortality in the affected children. Unlike adults, pediatric pancreatitis is more frequently associated with underlying structural abnormalities, trauma, and drugs rather than an idiopathic etiology. Magnetic resonance cholangiopancreatography (MRCP) is a good imaging modality for evaluating pancreatitis and determining etiology without exposure to radiation. This article focuses on MRCP findings associated with various causes of pancreatitis in children, particularly structural abnormalities of the pancreaticobiliary system, as well as describing the feasibility, limitations, and solutions associated with pediatric MRCP.

MODERN VIEWS ON ETIOLOGY OF CHRONIC PANCREATITIS AND CORRECTION OF FUNCTIONAL INSUFFICIENCY OF THE PANCREAS

Chronic pancreatitis is a multietiological disorder characterized by progressive structural changes of the pancreas and development of its eccrine and endocrine insufficiency. The potential causes of chronic pancreatitis in children include obstruction of the pancreas ducts due to cholelithiasis, chronic cholecystitis with biliary sludge, excretory ducts anomalies; obesity and hyperlipidemia; abdominal traumas and infectious pancreatic diseases. Recently new possible variants of chronic pancreatitis — autoimmune and hereditary — have been diagnosed due to the widening of diagnostic potentials. Fifty children and adolescents with chronic pancreatitis were diagnosed. It was shown, that obstructive chronic pancreatitis was found in 50%, obesity-associated. According to the literature, more than 70% of children with idiopathic chronic pancreatitis have genetic mutations in genes SFTR, PRSS1 and SPINK1, both single and associated. These lead to imbalance of the trypsinogen activation and inactivation in the pancreas tissue. Severe mutations can be an independent cause of chronic pancreatitis, mild ones manifest after the impact of some external factors. Regardless of the cause of the disease, the mandatory component of the treatment is enzyme replacement therapy with the preference to microspherical forms.

Acute pancreatitis in children

Background/purpose Acute pancreatitis in childhood is not common. It can be associated with severe morbidity and mortality. The role of clinical evaluation is vital as it can be misdiagnosed easily. The objective of this study was to review the etiology, presentation, diagnosis, management, and prognosis of acute pancreatitis in children and to assess the relevance of currently available prognostic criteria. Patients and methods Fifty children with acute pancreatitis admitted to the Pediatric Surgery Unit at the Al-Azhar University Hospitals, within the period January 1998 to December 2008 were retrospectively reviewed. They were diagnosed by clinical examination, laboratory, and radiological investigations, as well as by abdominal exploration. Results There were 25 boys and 25 girls. The median age was 9 years (range: 2–17 years). In the majority of cases, the main cause of acute pancreatic was idiopathic (17 patients), followed by trauma (10 patients). Most of the patients presented with abdominal pain (10 cases), vomiting (nine cases), jaundice (five cases), and an abdominal mass in computed tomography (48 cases). Conclusion Trauma is a major cause of pancreatitis in children. Early diagnosis, close monitoring, and proper intervention are mandatory to reduce the potential morbidity and mortality. Keywords : acute pancreatitis, children, morbidity, trauma

Acute Pancreatitis Due to Rotavirus Gastroenteritis in a Child

Serum amylase can be elevated in various pathological conditions, but its primary application is as a biochemical test for the diagnosis of acute pancreatitis. Acute gastroenteritis has not been widely recognized as a cause for hyperamylasemia and pancreatitis. We describe a case of acute pancreatitis after rotavirus gastroenteritis occurring in a previously healthy child. Rotavirus infection was demonstrated by detection of virus particles in stool culture and pancreatitis by raised serum amylase and lipase levels. No abnormalities were noticed during clinical follow-up. Further investigation to understand the role of rotavirus as a cause of pancreatitis in children may be helpful.

Dominant Dorsal Duct Syndrome

Acute recurrent pancreatitis in children can be caused by anomalies of fusion of pancreatic ducts such as the dominant dorsal duct syndrome wherein a dominant dorsal pancreatic duct is associated with stenosis of the minor papilla. Clinical presentations and management of 2 patients are discussed. An infant presented with severe acute pancreatitis with pseudocyst formation due to an underlying ductal disruption. Surgical treatment was offered on account of failure of medical therapy and endoscopic stenting. A dominant dorsal duct with minor papilla stenosis was encountered. Sphincteroplasty of the minor papilla and lateral pancreaticojejunostomy were performed with good result. A 14-year-old boy with a type 1 choledochal cyst was troubled by recurrent acute pancreatitis. At operation, a dilated dorsal pancreatic duct opening into a stenosed minor papilla was found in addition to the choledochal cyst. Choledochal cyst excision, choledochoduodenostomy, and sphincteroplasty of the minor papilla stenosis were performed. Dominant dorsal duct syndrome is a rare cause of acute pancreatitis in children. A high index of suspicion is necessary to establish a precise diagnosis. Sphincteroplasty of the minor papilla may affect adequate pancreatic drainage and prevent recurrent pancreatitis.

Disorders of the pediatric pancreas: imaging features

The purpose of this manuscript is to provide an overview of the normal development of the pancreas as well as pancreatic pathology in children. Diagnostic imaging plays a major role in the evaluation of the pancreas in infants and children. Familiarity with the range of normal appearance and the diseases that commonly affect this gland is important for the accurate and timely diagnosis of pancreatic disorders in the pediatric population. Normal embryology is discussed, as are the most common congenital anomalies that occur as a result of aberrant development during embryology. These include pancreas divisum, annular pancreas, agenesis of the dorsal pancreatic anlagen and ectopic pancreatic tissue. Syndromes that can manifest pancreatic pathology include: Beckwith Wiedemann syndrome, von Hippel-Lindau disease and autosomal dominant polycystic kidney disease. Children and adults with cystic fibrosis and Shwachman-Diamond syndrome frequently present with pancreatic insufficiency. Trauma is the most common cause of pancreatitis in children. In younger children, unexplained pancreatic injury must always alert the radiologist to potential child abuse. Pancreatic pseudocysts are a complication of trauma, but can also be seen in the setting of acute or chronic pancreatitis from other causes. Primary pancreatic neoplasms are rare in children and are divided into exocrine tumors such as pancreatoblastoma and adenocarcinoma and into endocrine or islet cell tumors. Islet cell tumors are classified as functioning (insulinoma, gastrinoma, VIPoma and glucagonoma) and nonfunctioning tumors. Solid-cystic papillary tumor is probably the most common pancreatic tumor in Asian children. Although quite rare, secondary tumors of the pancreas can be associated with certain primary malignancies.

Pancreatitis: evaluation with MR cholangiopancreatography in children.

To determine the usefulness of magnetic resonance (MR) cholangiopancreatography in assessing the cause of pancreatitis in children. Twenty healthy volunteers (aged 2-11 years) and 10 patients with acute pancreatitis (aged 3-12 years) who underwent MR cholangiopancreatography between December 1993 and February 1996 were studied retrospectively. The rate of visualization of the common bile duct and main pancreatic duct with MR cholangiopancreatography was assessed in the volunteer group. Depiction of pancreaticobiliary disease at MR cholangiopancreatography was assessed in the patient group. MR cholangiopancreatography clearly showed the common bile duct in 20 of 20 volunteers (100%) and the main pancreatic duct in 13 of 20 volunteers (65%). MR cholangiopancreatography depicted a dilated common bile duct in six of 10 patients (60%) and an abnormal arrangement of the pancreaticobiliary duct in five of the six patients (83%) in whom this structural abnormality was proved at surgery. In the four patients without structural abnormality, MR cholangiopancreatography depicted a pseudocyst in one patient who had traumatic pancreatitis; the other three patients had normal findings. In one of these three patients, familial pancreatitis was considered to be the underlying disorder, and in the other two patients no cause was identified. MR cholangiopancreatography may be helpful in diagnosing the cause of pancreatitis in children, especially in those with an abnormal pancreaticobiliary ductal junction.

Implications of molecular diagnostic testing in families with hereditary pancreatitis.

Hereditary Pancreatitis (HP), is an autosomal dominant trait, which presents with recurrent attacks of abdominal pain, and is the most common cause of chronic relapsing pancreatitis in children. In addition to recurring episodes of intense epigastric pain, patients have nausea, vomiting, and anorexia, and typically show elevated serum amylase levels during the acute episode that can rapidly decline in convalescence. Complications of long-standing disease include features of chronic pancreatitis, such as pancreatic pseudo-cyst, exocrine and endocrine failure, parenchymal calcification, and pancreatic cancer. A large family from Virginia, which was originally studied by Katwinkle and Lapey in 1973, was re-ascertained through a new proband. Linkage studies in this family mapped the gene to the 7q35 region, with similar results being reported simultaneously by two other groups. A pathogenic G to A transition mutation in exon 3 of the cationic trypsinogen (CT) gene, which had previously been mapped to this region, was found both in our family as well as other families from North America. Many other conditions can produce abdominal symptoms that are often mis-attributed to the disease in HP families. An affected member of our family in whom the mutation was confirmed by direct sequencing of exon 3 of the cationic trypsinogen gene requested diagnostic testing on his 4-year-old son because of onset of severe abdominal pain and vomiting. Screening for the mutation in this child did not reveal the pathogenic G to A change. These results prevented unnecessary invasive diagnostic procedures and treatment in this child. The pre-symptomatic testing of high risk individuals could, thus, have a significant impact on the well being of both affected and normal family members.

Pancreatitis and anomalous union of the pancreaticobiliary ductal system in childhood

From January 1978 to December 1989, 48 patients were diagnosed as having anomalous union of the pancreaticobiliary ductal system (AUPBD) at the Second Department of Surgery, Kanazawa University Hospital and its affiliated hospitals. Among these 48 patients, 13 (28.1%) were children under 13 years of age. Four of these patients had acute pancreatitis. The clinical, radiological, and surgical features of these patients are presented. The chief presenting complaint was epigastric pain in all cases; three patients had recurrent episodes of epigastric pain and had been diagnosed as having autotoxicosis. AUPBD was clearly demonstrated in all patients, three by endoscopic retrograde cholangiopancreatography (ERCP) and one by operative cholangiography. At operation, macroscopic evidence of pancreatitis was recognized in all cases. In one case, roentogenolucent pancreaticolithiases were seen on ERCP. We consider AUPBD as an important cause of pancreatitis in children and advocate ERCP in children who are suspected having biliary tract or pancreatic disease. The diagnosis of AUPBD should be considered when children with abdominal pain and elevated serum or urinary amylase levels are evaluated.

Beneficial use of an evocative test in chronic relapsing pancreatitis in children

The true incidence and cause of chronic recurrent pancreatitis in children remains enigmatic because little is known about its early natural history, it is considered only infrequently, and diagnosis is difficult. Chronic recurrent abdominal pain in children continues to be common. To help evaluate the possibility that such pain is related to chronic recurrent pancreatitis, this study used the morphine-prostigmine pancreatic evocative test with the recent addition of concomitant pancreatic ultrasonography to evaluate ductal activity. Fourteen of 67 children studied had positive results and 13 underwent operation, which included 2 partial pancreatectomies and 12 sphincteroplasties in 12 patients. At last follow-up seven were asymptomatic, five were significantly improved, and one who had pancreatography only continued to have pain. The remaining patient, who has not yet operated on, continues to have pain. This series supports the use of the morphine-prostigmine test to determine which patients have abdominal pain that is potentially related to pancreatitis and which patients would benefit from operation.

Pancreatitis in children. A study in the North of England.

Cases of pancreatitis in children in the Newcastle Regional Board area were studied over approximately 6 years. There were 9 cases aged between 6 weeks and 15 years. In 5 children (all under 7 years of age) likely aetiological factors were found (2 cases of mumps and 1 case wach due to trauma, measles, and hereditary pancreatitis). In 4 children all over 13 years of age no likely aetiological factor was found. It is speculated that they may represent one end of the age spectrum of idiopathic pancreatitis as it occurs in adults. Hereditary pancreatis was definitely found in only one child and possibly in one other. Therefore, it probably does not represent the major cause of pancreatitis in children as has been previously thought. One child died, but all the other children have thrived since their illness.