Pancreatitis: etiology, diagnosis, and management

Inflammation of the pancreas (pancreatitis) has many presentations in child ren and adolescents, ranging from intrauterine congenital onset with sequel ae of early exocrine pancreatic insufficiency as in the diseases of cystic fibrosis and Shwachman-Diamond syndrome to postnatal onset as a consequence of embryologic anomalies affecting pancreatic drainage postulated to exist in pancreas divisum, or of traumatic, obstructive, hemodynamic, metabolic or biochemical insults. The etiology is often elusive with up to 30% of cas es being idiopathic. Modern imaging modalities of endoscopic ultrasonograph y and magnetic resonance cholangiopancreatography extend the diagnostic pow er of conventional abdominal ultrasonography and computed tomography. In ad dition, there is increasing pediatric experience with endoscopic retrograde cholangiopancreatography. Medical management remains supportive, with opti mal timing and indications for surgery in cases of pancreatic necrosis and pseudocyst assessed. Three temporal patterns of pancreatitis appear in chil dren: acute pancreatitis, recurrent acute pancreatitis, and chronic pancrea titis. Acute pancreatitis is of abrupt onset, often attributable to a speci fic cause, and of variable severity and duration but self-limited with even tual resolution. Acute attacks of pancreatitis recurring after periods of r emission characterize acute recurrent pancreatitis and indicate an intrinsi c problem or susceptibility. Chronic pancreatitis is present in most of the se cases in which pancreatic inflammation and destruction never completely remits. Curr Opin Pediatr 2001, 13:447-451 (C) 2001 Lippincott Williams & W ilkins, Inc.