MANAGEMENT OF FIBROSING PANCREATITIS IN CHILDREN PRESENTING WITH OBSTRUCTIVE-JAUNDICE

Background-Children with fibrosing pancreatitis are conventionally tre ated surgically to relieve common bile duct (CBD) obstruction caused b y pancreatic compression. Residual pancreatic function has not been fo rmally tested in these patients. Aims-To evaluate the usefulness of no nsurgical temporary drainage in children with fibrosing pancreatitis a nd to assess pancreatic function after resolution of their CBD obstruc tion. Patients-Four children (1.5-13 years; three girls). Methods and results-Abdominal sonography and computed tomography revealed diffuse enlargement of the pancreas, predominantly the head. The CBD was dilat ed due to compression by the head of the pancreas. Pancreatic biopsy s pecimens obtained in three patients showed notable acinar cell atrophy and extensive fibrosis. Cystic fibrosis was excluded. No other cause of pancreatitis was identified. Pancreatic tissue from one patient con tained viral DNA sequences for parvovirus B19 detected by polymerase c hain reaction; serum IgM to parvovirus was positive. Three patients ha d temporary drainage of the CBD and one patient underwent a choledocho jejunostomy. Serial imaging studies revealed resolution of the CBD obs truction with reduction in pancreatic size. Exocrine pancreatic functi on deteriorated. Three patients developed pancreatic insufficiency wit hin two to four months of presentation. The fourth patient has notably diminished pancreatic function, but remains pancreatic sufficient. No ne has diabetes mellitus. Conclusions-Temporary drainage of the CBD ob struction is recommended in fibrosing pancreatitis in children along w ith close monitoring of the clinical course, before considering surger y.