Acute pancreatitis in children and adolescents

Table 1 Etiology of childhood acute pancreatitis

Congenital anomalies, periampullary obstruction

Choledochal cyst, abnormal union of the pancreaticobiliary junction, gallstone, cholecystitis, pancreatic divisum, tumor, ascaris aberrant

Infectious

Mumps, measles, coxsackie, echo, lota, influenza, epstein-barr virus, Mycoplasma, salmonella, gram-negative bacteria

Drugs

L-asparaginase, steroid, valproic acid, azathioprine, Mercaptopurine, mesalazine, Cytarabine, Salicylic acid, indomethacin, tetracycline, chlorothiazide, isoniazid, anticoagulant drug, borate, alcohol

Trauma

Blunt injury, child abuse, ERCR, After surgery

Systemic disease

Reye syndrom, systemic lupus erythematosus, polyarteritis nodosa, Juvenile rheumatoid arthritis, sepsis, multiple organ failure, Organ transplantation, hemolytic-uremic syndrome, henoch-schoenlein purpura, kawasaki disease, inflammatory bowel disease, chronic intestinal pseudo-obstruction, gastric ulcer, anorexia nervosa, food allergy, cystic fibrosis

Metabolic

Hyperlipoproteinemia (I, IV, V), hypercalcemia, diabetes, α1 antitrypsin deficiency

Nutrition

Malnutrition, high-calorie infusion, vitamin A and D deficiency

Others

Familial, idiopathic

ERCP: Endoscopic retrograde cholangiopancreatography.

Table 2 Cause of acute pancreatitis in children and adolescents

Ref.	Location	Cases	Etiology (%)Systemic	Biliary1	Anatomic2	Trauma	Familial	Metabolic3	Drugs	Others4	Idiopathic
Lopez[50]	United States	274	48	10	NA	19	NA	0.7	5	0.4	17
DeBanto et al[1]	United States	301	3.5	10.5	1.5	13.5	5.5	4	11	16.5	34
Werlin et al[8]	United States	180	14	12	7.5	14	3	5.5	12	24	8
Nydegger et al[4]	Australia	279	22.2	5.4	NA	36.3	NA	5.8	3.2	2.2	25.1
Suzuki et al[19]	Japan	135	8.9	30.4	25.9	9.6	NA	NA	11.1	3.7	10.4
Lantz et al[2]	United States	211	3.3	11.8	5.2	7.6	0.9	6.2	19.9	13.8	31.3

All studies contained more than 100 cases. NA: Not available.

¹Gallstone, biliary sludge, choledochal cyst;

²Abnormal union of the pancreaticobiliary junction, pancreatic divisum;

³Diabetic acidosis, hyperlipidemia, organic acidemias, hypercalcemia;

⁴Associated viral infection, postendoscopic retrograde cholangiopancreatography, alcohol, autoimmune, cystic fibrosis, post-surgery.

Table 3 First symptoms and chief complaints by age n (%)

	Age, yr
	1-5(n = 53)	6-10(n = 47)	11-17(n = 35)	Total(n = 135)
Abdominal pain	46 (86.8)	39 (83.0)	32 (91.4)	116 (85.9)
Fever	21 (39.6)	21 (44.7)	10 (28.6)	52 (38.5)
Vomiting	29 (54.7)	16 (34)	6 (17.1)	51 (37.8)
Jaundice	9 (17)	2 (4.3)	0	11 (8.1)
Back pain	0	1 (2.1)	5 (14.3)	6 (4.4)
Pale stool	3 (5.7)	1 (2.1)	0	4 (3)
Diarrhea	0	1 (2.1)	2 (5.7)	3 (2.2)
Loss of consciousness	1 (1.9)	1 (2.1)	1 (2.0)	3 (2.2)
Others	5 (9.5)	2 (4.2)	2 (5.8)	9 (6.6)