Successful conservative management of idiopathic fibrosing pancreatitis in children

Abstract

With careful radiological and biochemical assessment and monitoring, invasive surgery can be avoided in the management of fibrosing pancreatitis. The eventual outcome is no different from reported surgically treated cases.

Idiopathic fibrosing pancreatitis and spontaneous resolution of pancreatic masses in children

“…In a smaller number of patients stenting (with or without biopsy) has been carried out either surgically [18], percutaneously [18] or endoscopically [7,8,18,19]. In the former report [18] three of four patients (aged 1.5-13 years) underwent temporary stenting, with resolution of jaundice allowing stent removal at 2-4 months without further complications, at 1.5 to 3.5 years follow up [18], a situation parallelling our 3rd case.…”

“…No precipitating factor can be identified and the serum amylase is normal or mildly elevated. Fifty-seven cases have previously been described with a slight male preponderance (age range 4 months-20 years, mean 10 years) [6][7][8]. Radiological imaging typically demonstrates a pancreatic mass or enlargement with dilatation of the intra and extra hepatic biliary tree where jaundice is present (72% of previously reported cases [6][7][8]).…”

“…Fifty-seven cases have previously been described with a slight male preponderance (age range 4 months-20 years, mean 10 years) [6][7][8]. Radiological imaging typically demonstrates a pancreatic mass or enlargement with dilatation of the intra and extra hepatic biliary tree where jaundice is present (72% of previously reported cases [6][7][8]). Histology shows fibrosis of the pancreas with relative preservation of acinar structure and no evidence of auto digestion [8][9][10].…”

“…In the former report [18] three of four patients (aged 1.5-13 years) underwent temporary stenting, with resolution of jaundice allowing stent removal at 2-4 months without further complications, at 1.5 to 3.5 years follow up [18], a situation parallelling our 3rd case. Another report [7] performed endoscopic drainage in one patient, again, with subsequent removal without complications. In one report [19] on temporary drainage, however, the authors subsequently undertook elective duodenum preserving pancreatectomy in both their patients (aged 16 and 17 years) and recommend this as the ideal surgical solution, regarding surgical intervention as mandatory in their 2002 paper.…”

“…Tropical pancreatitis, common in certain regions of the tropics, also presents in childhood and adolescence with pain and diabetes [5]. Idiopathic fibrosing pancreatitis is a rare cause of obstructive jaundice and abdominal pain in childhood and adolescence with some 57 cases previously reported in the literature [6][7][8], over half of whom had obstructive jaundice. Little data is available on its natural history.…”