INFLUENCE OF SEVERE UNDERLYING PATHOLOGY AND HYPOVOLEMIC SHOCK ON THEDEVELOPMENT OF ACUTE-PANCREATITIS IN CHILDREN

Acute pancreatitis in children is a little known and poorly defined di sease, and thus rarely considered in the diagnosis of pediatric abdomi nal pain, In the past 14 years, the authors treated 21 children who ha d acute pancreatitis. Trauma was the cause of the disease in 29% of th e patients. One third (33%) had hypovolemic shock-related pancreatitis (mostly after either cardiopulmonary bypass or severe gastrointestina l bleeding). Furthermore, a major proportion (38%) had severe underlyi ng organic disease. The clinical presentation was unremarkable; most p atients (83%) had abdominal pain, especially in the epigastrium, and v omiting was the only other clinical sign exhibited by more than 50%, T he Glasgow score Ja severity grading system based on eight laboratory values and calculated within the first 48 hours after admission) had g ood specificity but poor sensitivity. Amylasemia bad no predictive val ue. More than half our patients (57%) had complications, mainly pseudo cysts (24%) and relapse (14%), and about one quarter (24%) had severe pancreatitis. There were two deaths (10%), and all surviving children (90%) eventually were symptom-free. Treatment was conservative in the majority of cases; eight patients (38%) required surgery, Hypovolemic shock and a severe underlying pathology were identified as risk factor s for the occurrence of severe pancreatitis (P < .005) or death (P < . 001), but not for the development of complications. Copyright (C) 1996 by W.B. Saunders Company