Pancreatitis in children is relatively rare but may be increasing in frequency. Two main patterns of disease exist in children: acute pancreatitis, which accounts for 75% of all cases, is abrupt in onset but usually self-limiting; and chronic pancreatitis, in which pancreatic inflammation and gland destruction are progressive.

Acute pancreatitis

Etiology

Although the pathophysiology and functional consequences of acute pancreatitis in children are identical to those observed in adults, etiology differs significantly (Table 40.1). In children, drugs and toxins (12%–18%) and systemic disease (12%–35%) are major causes of acute pancreatitis. Abdominal trauma is another important cause of acute pancreatitis, accounting for between 14% and 29% of cases; it may be related to blunt abdominal trauma, surgical trauma, or, in some instances, to child abuse. Up to 25% of cases are idiopathic, although this proportion is less in more recent series. Recurrent acute pancreatitis, characterized by repeated acute episodes, is associated with obstructive disease, such as pancreatic ductal abnormalities, biliary tract obstruction, duplication cyst and biliary lithiasis. Pancreas divisum is the most frequently encountered pancreatic malformation present in as many as 10%–15% of patients undergoing magnetic resonance cholangiopancreatography; this anomaly is associated with 2.5% of acute pancreatitis in children. Acute pancreatitis can occur within the first month of life, but most cases present around the age of 5 years and during adolescence.

Diagnosis

Diagnosis of acute pancreatitis can be difficult and outcome unpredictable at onset, as several local, regional and systemic insults can hamper the diagnosis and affect the prognosis.