Acute Necrotizing Pancreatitis in Children

Raizner, Aileen; Phatak, Uma Padhye; Baker, Kenneth E.; Patel, Mohini; Husain, Sohail Z.; Pashankar, Dinesh S.

doi:10.1016/j.jpeds.2012.09.037

Cited by 36 publications

(41 citation statements)

References 20 publications

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“…According to the literature [19], necrotizing pancreatitis occurs in less than 1% of children with AP. Among the ve large sample pediatric cases reported in the United States [20], only 3 of 1014 children with AP had pancreatic necrosis, which was signi cantly less severe than that of adults.…”

Section: Discussionmentioning

confidence: 99%

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

Zhong

Tan

Yan

et al. 2020

Preprint

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Background: The diagnosis of pediatric pancreatitis has been increasing over the last 20 years. We aimed to compare the clinical characteristics for pediatric acute pancreatitis (AP) with adult AP, and investigate the risk factor for acute recurrent pancreatitis (ARP) in children. Method: From June 2013 to June 2019, a total of 130 pediatric patients with AP at the inpatient database were enrolled. Univariate analysis and multivariate Cox regression analysis were performed to identify the risk factors for ARP in children. Result: Major etiologic factors in 130 patients were biliary (31.5%), idiopathic (28.5%), trauma (16.2%). There was a significant difference in the constituent ratio of etiology between pediatric patients and adult patients (p<0.001). Compared with the adult patients, the pediatric patients had significantly lower severity (p=0.012) and occurrence rate of pancreatic necrosis (p=0.02). During the follow-up time (34.2±20.8 months), 19 children (14.6%) developed into ARP. Multivariate Cox regression analysis showed that female (p=0.025; OR=3.632; 95%confidence interval(CI) 1.179-11.188), hyperlipidemia (p=0.022; OR=3.480; 95%CI 1.201-10.085), pancreatic necrosis (p=0.001; OR=8.815; 95%CI 2.446-31.774) were the independent risk factors of ARP. The risk of recurrence was significantly different in each etiology group. Hyperlipidemic AP had the highest risk of recurrence over time, while viral and drug-induced AP had the lowest risk of recurrence (p=0.035).Conclusion: Biliary and idiopathic disease were the major etiologies of AP in children. Compared to adults, children tend to have milder disease conditions and a better prognosis. Female, hyperlipidemia, and first AP attack with pancreatic necrosis were associated with the increased risk of ARP.

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Section: Discussionmentioning

confidence: 99%

Clinical characteristics of acute pancreatitis in children: a single-center experience in Western China

Zhong

Tan

Yan

et al. 2020

Preprint

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“…1 El dolor abdominal suele ser de inicio brusco, continuo y ocasiona una posición antiálgica. En casos graves, puede aparecer una coloración azulada periumbilical (signo de Cullen) y en los flancos (signo de Grey Turner) o desarrollarse derrame pleural, ascitis, ictericia e, incluso, un síndrome de respuesta inflamatoria sistémica con fallo multiorgánico y elevada morbimortalidad (en torno a 17%).…”

Section: Comentariosunclassified

“…1,6 La ecografía abdominal es la primera prueba de imagen por realizar, y se reserva la TAC para los casos de evolución desfavorable. La gravedad y el riesgo de complicaciones asociadas puede valorarse mediante TAC según el puntaje de Balthazar, que otorga una puntuación en función del grado de inflamación y de necrosis (de menor grado, A, a mayor, E).…”

Section: Comentariosunclassified

“…La gravedad y el riesgo de complicaciones asociadas puede valorarse mediante TAC según el puntaje de Balthazar, que otorga una puntuación en función del grado de inflamación y de necrosis (de menor grado, A, a mayor, E). 1 Varios estudios señalan que el puntaje de Balthazar es superior a los sistemas de puntuación clínica clásicamente utilizados, como los de DeBanto 2,6,7 (Tabla 1). Los casos no complicados suelen evolucionar 1 En el caso de causa litiásica sospechada o probada, se recomienda la extracción de cálculos mediante colangiopancreatografía retrógrada endoscópica o, incluso, la colecistectomía.…”

Section: Comentariosunclassified

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Pancreatitis necrohemorrágica en un niño de 11 años. Caso clínico

Lozón¹,

Blázquez²,

Arias³

et al. 2015

Arch Argent Pediat

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Presentación de casos clínicos RESUMENLa pancreatitis aguda es un problema emergente, con una incidencia de 3,6-13,2 casos/100 000 niños. Sin embargo, la pancreatitis necrotizante (necrosis mayor del 30% del páncreas y/o mayor de 3 cm de un área del páncreas) es un proceso poco frecuente (< 1% de las pancreatitis agudas), con presentación similar a los casos de pancreatitis no complicada y con una elevada morbimortalidad. La tomografía axial computada permite valorar, en estos casos, la gravedad del cuadro y el riesgo de complicaciones (puntaje de Balthazar). Las pancreatitis no complicadas tienen una evolución favorable, pero los casos de pancreatitis necrotizante precisan tratamiento médico intensivo y, en ocasiones, cirugía. Presentamos el caso de un varón de 11 años con clínica compatible con una pancreatitis aguda confirmada mediante ecografía abdominal. Ante el empeoramiento analítico, se realizó una tomografía axial computada, que mostró una pancreatitis necrotizante y pseudoquistes de gran tamaño. Se decidió la monitorización estrecha y la adopción de una actitud conservadora, con mejoría clínico-analítica. Después de un año de seguimiento, el paciente permanece asintomático y han desaparecido los pseudoquistes. La pancreatitis necrohemorrágica es una entidad infrecuente en la edad pediátrica pero potencialmente grave que debemos tener presente en el diagnóstico diferencial de un abdomen agudo. Palabras clave: pancreatitis aguda, pancreatitis necrotizante, pseudoquistes, niños. ABSTRACTAcute pancreatitis is an emerging problem with an incidence between 3.6 and 13.2 cases/100,000 children. However, necrotizing pancreatitis (necrosis greater than 30% of the pancreas and/or greater than 3 cm in an area of the pancreas) is a rare condition (< 1% of acute pancreatitis), with a presentation similar to not complicated pancreatitis cases and with high morbidity and mortality. Computed tomography allows an assessment of the severity of the disease and the risk of complications (Balthazar Score). Not complicated pancreatitis cases have a favorable outcome, but necrotizing pancreatitis cases require intensive medical treatment and sometimes surgical treatment.

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“…Age is one of the indices used to grade the severity of AP in clinical scoring systems such as the Ranson criteria [5], the Bedside Index for Severity in Acute Pancreatitis [6] and the Acute Physiology and Chronic Health Evaluation II [7]. In addition, in recent years, some researchers have studied the relationship between age and AP and found that different age stages have certain unique characteristics of AP, such as incidence, etiology, mortality [8][9][10], and there are also studies analyzing AP in certain age stage [11,12]. In clinical practice, we have found that the progression and prognosis of ANP are not completely the same in patients of different ages.…”

Section: Introductionmentioning

confidence: 99%