ORIGINAL ARTICLE

CASE REPORT Pancreatitis in Children

ȱ’ŸŽȱŽŠ›ȱŽŸ’Ž ȱ˜ȱŠ—Œ›ŽŠ’’œȱŠ–˜—ȱ’•’™’—˜ȱ‘’•›Ž—ȱ
ȱ
Šǯȱ‘Š›’—Šȱǯȱ’£˜—ǰȱ Ž›–Š—Šȱǯȱ ›Ž˜›’˜ȱŠ—ȱ•’£Š‹Ž‘ȱ ǯȱŠ›’—Ž£ȱ
ȱ
ŽŒ’˜—ȱ˜ȱŽ’Š›’Œȱ Šœ›˜Ž—Ž›˜•˜¢ǰȱ
Ž™Š˜•˜¢ȱŠ—ȱž›’’˜—ǰȱ˜••ŽŽȱ˜ȱŽ’Œ’—ŽȱŠ—ȱ‘’•’™™’—Žȱ Ž—Ž›Š•ȱ
˜œ™’Š•ǰȱ
—’ŸŽ›œ’¢ȱ˜ȱ‘Žȱ‘’•’™™’—ŽœȱŠ—’•Šȱ
ȱ
ȱ
ABSTRACT ’—ȱ™Š—Œ›ŽŠ’ŒȱŽ—£¢–Žȱ•ŽŸŽ•œȱ’—ȱ‘Žȱ‹•˜˜ǯŗȱȱȱŠ—Œ›ŽŠ’’œȱ–Š¢ȱ
Background. Pancreatitis is uncommon in childhood and there is Ž’‘Ž›ȱ‹ŽȱŠŒžŽȱ˜›ȱŒ‘›˜—’Œǯȱ ˜ȱ˜ȱ‘Žȱ˜••˜ ’—ȱ‘›ŽŽȱŒ›’Ž›’Šȱ
presently no study among Filipino children. ‹ŠœŽȱ˜—ȱ‘Žȱ•Š—ŠȱŒ•Šœœ’’ŒŠ’˜—ȱŠ›ŽȱžœŽȱ’—ȱ‘Žȱ’Š—˜œ’œȱ
˜ȱ ŠŒžŽȱ ™Š—Œ›ŽŠ’’œDZȱ ǻŗǼȱ ŠŒžŽȱ Š‹˜–’—Š•ȱ ™Š’—ȱ Š—ȱ
Objective. To determine the clinical features and outcome of
Ž—Ž›—Žœœȱ ’—ȱ ‘Žȱ ž™™Ž›ȱ Š‹˜–Ž—Dzȱ ǻŘǼȱ Ž•ŽŸŠŽȱ •ŽŸŽ•œȱ ˜ȱ
pancreatitis among Filipino children.
™Š—Œ›ŽŠ’Œȱ Ž—£¢–Žœȱ ’—ȱ ‹•˜˜ǰȱ ž›’—Žǰȱ ˜›ȱ ŠœŒ’’Œȱ •ž’ȱ Šȱ •ŽŠœȱ
Method. Review of medical records of all patients diagnosed to ‘›ŽŽȱ ’–Žœȱ ‘Žȱ ž™™Ž›ȱ •’–’ȱ ˜ȱ —˜›–Š•Dzȱ Š—ȱ ǻřǼȱ ™›ŽœŽ—ŒŽȱ ˜ȱ
have pancreatitis based on standard criteria from 2005 to 2009. Š‹—˜›–Š•ȱ ’–Š’—ȱ ’—’—œȱ ’—ȱ ‘Žȱ ™Š—Œ›ŽŠœȱ ‘Šȱ Š›Žȱ
Šœœ˜Œ’ŠŽȱ  ’‘ȱ ŠŒžŽȱ ™Š—Œ›ŽŠ’’œǯŘȱ ‘›˜—’Œȱ ™Š—Œ›ŽŠ’’œȱ ’œȱ
Results. A total of 23 children (mean age: 12 years; 13 male, 10 Œ˜—œ’Ž›Žȱ ’ȱ ’–Š’—ȱ œž’Žœȱ Ž–˜—œ›ŠŽȱ ™Š—Œ›ŽŠ’Œȱ
female) were included, 21 with acute and two with chronic ŒŠ•Œ’’ŒŠ’˜—œǰȱžŒŠ•ȱœ˜—Žœȱ˜›ȱ’—›ŠžŒŠ•ȱŒ‘Š—Žœȱ›ŽŠ›•Žœœȱ
pancreatitis. Twenty one (91%) presented with abdominal pain ˜ȱŠ–¢•ŠœŽȱŠ—ȱ•’™ŠœŽȱ•ŽŸŽ•œǯřȱ
and two with jaundice. Nine had idiopathic pancreatitis. In 14
‘Žȱ Œ•’—’ŒŠ•ȱ ŽŠž›Žœȱ Š—ȱ ›ŽŠ–Ž—ȱ Ž™Ž—ȱ ˜—ȱ ‘Žȱ
patients, the etiology was identified: bile duct obstruction (7),
trauma (2), drugs (2), infection (2) and hypertriglyceridemia (1). œŽŸŽ›’¢ȱ ˜ȱ ‘Žȱ ’œŽŠœŽǯȱ Š—Œ›ŽŠ’’œȱ ŒŠ—ȱ ‘ŠŸŽȱ œŽŸŽ›Žȱ
Only four of 20 patients with ultrasound examination showed an Œ˜–™•’ŒŠ’˜—œȱ Š—ȱ ‘’‘ȱ –˜›Š•’¢ȱ Žœ™’Žȱ ›ŽŠ–Ž—ǯȱ ‘Žȱ
enlarged pancreas. Complications were pseudocyst formation ’œŽŠœŽȱ ’œȱ ›ŽšžŽ—•¢ȱ ›Ž™˜›Žȱ ’—ȱ Šž•œŚȱ ‹žȱ ›Š›Ž•¢ȱ ’—ȱ
(6), pancreatic abscess (4), diabetes mellitus (2) and Œ‘’•›Ž—ȱ Š—ȱ ›Žšž’›Žœȱ Šȱ ‘’‘ȱ ’—Ž¡ȱ ˜ȱ œžœ™’Œ’˜—ȱ ˜›ȱ
hypocalcemia (1). Of the 23 patients, eight required surgery: ’Š—˜œ’œǯȱ —ȱ ‘Žȱ ‘’•’™™’—Žœǰȱ ‘Ž›Žȱ Š›Žȱ œŽŸŽ›Š•ȱ ™ž‹•’œ‘Žȱ
pancreatic debridement (4), choledochal cyst excision (2), ›Ž™˜›œȱ ˜ȱ ™Š—Œ›ŽŠ’’œȱ ’—ȱ Šž•œśǰŜȱ ‹žȱ —˜—Žȱ ’—ȱ Œ‘’•›Ž—ǯȱ ȱ
cholecystectomy (1) and Whipple’s procedure (1). All œž›ŸŽ¢ȱ ˜ȱ ‘Žȱ ŒŠœŽœȱ Šȱ ‘Žȱ ‘’•’™™’—Žȱ Ž—Ž›Š•ȱ
˜œ™’Š•ǰȱ Šȱ
pseudocysts resolved spontaneously. One patient with
Ž›’Š›¢ȱ ›ŽŽ››Š•ȱ –Ž’ŒŠ•ȱ ŒŽ—Ž›ǰȱ œ‘˜ Žȱ ˜—•¢ȱ Šȱ ˜Š•ȱ ˜ȱ ’ŸŽȱ
pancreatic tumor declined surgery and another with pancreatitis
due to choledochal cyst died of sepsis. ŒŠœŽœȱ ›˜–ȱ ŘŖŖŖȱ ˜ȱ ŘŖŖŚǰȱ ‹žȱ ‘Ž›ŽŠŽ›ǰȱ Š—ȱ ’—Œ›ŽŠœŽȱ ’—ȱ
›ŽšžŽ—Œ¢ȱ Šœȱ˜‹œŽ›ŸŽǯȱȱȱ
Conclusions. In our study, severe abdominal pain was the most ‘Žȱ ˜‹“ŽŒ’ŸŽȱ ˜ȱ ‘’œȱ œž¢ȱ ’œȱ ˜ȱ ŽŽ›–’—Žȱ ‘Žȱ Œ•’—’ŒŠ•ȱ
frequent presenting symptom of childhood pancreatitis. Sixty ŽŠž›Žœȱ Š—ȱ ˜žŒ˜–Žȱ ˜ȱ ™Š—Œ›ŽŠ’’œȱ Š–˜—ȱ ’•’™’—˜ȱ
percent had an identifiable cause for pancreatitis. A favorable Œ‘’•›Ž—ǯȱ
outcome was observed. ȱ
Ž‘˜œȱ
Key Words: bile duct obstruction, severe abdominal pain,
ȱ ›ŽŸ’Ž ȱ ˜ȱ –Ž’ŒŠ•ȱ ›ŽŒ˜›œȱ  Šœȱ ˜—Žȱ ˜—ȱ Š••ȱ Œ‘’•›Ž—ȱ
pancreatic pseudocyst
’Š—˜œŽȱ ˜ȱ ‘ŠŸŽȱ ™Š—Œ›ŽŠ’’œȱ ‹¢ȱ ‘Žȱ ŽŒ’˜—ȱ ˜ȱ Ž’Š›’Œȱ
ȱ
Šœ›˜Ž—Ž›˜•˜¢ǰȱ
Ž™Š˜•˜¢ȱ Š—ȱ ž›’’˜—ȱ ˜ȱ ‘Žȱȱ
—›˜žŒ’˜—ȱ
‘’•’™™’—Žȱ Ž—Ž›Š•ȱ
˜œ™’Š•ȱ‹Ž ŽŽ—ȱŘŖŖśȱ˜ȱŘŖŖşǯȱȱ™Š’Ž—ȱ
ŒžŽȱ ™Š—Œ›ŽŠ’’œȱ ǻǼȱ ’œȱ Š—ȱ ’—•Š––Š’˜—ȱ ˜ȱ ‘Žȱ
 Šœȱ’Š—˜œŽȱ˜ȱ‘ŠŸŽȱŠŒžŽȱ ™Š—Œ›ŽŠ’’œȱ’—ȱ‘Žȱ™›ŽœŽ—ŒŽȱ˜ȱ
™Š—Œ›ŽŠœȱ Šœȱ Šȱ ›Žœž•ȱ ˜ȱ ‘Žȱ œžŽ—ȱ ›Ž•ŽŠœŽȱ ˜ȱ ŠŒ’ŸŠŽȱ
 ˜ȱ ˜ȱ ‘Žȱ ˜••˜ ’—ȱ ‘›ŽŽȱ Œ›’Ž›’ŠDZŘȱ ǻŗǼȱ ¢™’ŒŠ•ȱ Œ•’—’ŒŠ•ȱ
™Š—Œ›ŽŠ’Œȱ Ž—£¢–Žœȱ •ŽŠ’—ȱ ˜ȱ ’Žœ’˜—ȱ ˜ȱ ‘Žȱ ™Š—Œ›ŽŠ’Œȱ
–Š—’ŽœŠ’˜—ȱǻœŽŸŽ›ŽȱŠ‹˜–’—Š•ȱ™Š’—ǰȱŠ—˜›Ž¡’Šǰȱ—ŠžœŽŠȱŠ—ȱ
™Š›Ž—Œ‘¢–Šȱ Š—ȱ ˜‘Ž›ȱ ›Ž’˜—Š•ȱ ’œœžŽœȱ  ’‘ȱ Šœœ˜Œ’ŠŽȱ ›’œŽȱ
Ÿ˜–’’—ǼDzȱ ǻŘǼȱ ’—Œ›ŽŠœŽȱ œŽ›ž–ȱ Œ˜—ŒŽ—›Š’˜—ȱ ˜ȱ ™Š—Œ›ŽŠ’Œȱ
Ž—£¢–ŽœȱřȮŚȱ’–ŽœȱŠ‹˜ŸŽȱ—˜›–Š•ȱ•’–’œDzȱŠ—ȱǻřǼȱœ˜—˜›Š™‘’Œȱ
ȱ
˜›ȱ ›Š’˜•˜’Œȱ ŽŸ’Ž—ŒŽȱ ˜ȱ ™Š—Œ›ŽŠ’Œȱ ’—•Š––Š’˜—ǯȱ —ȱ ‘Žȱ
ȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȏȱ
™›ŽœŽ—ŒŽȱ˜ȱ™Š—Œ›ŽŠ’ŒȱŒŠ•Œ’’ŒŠ’˜—ǰȱ™Š—Œ›ŽŠ’ŒȱžŒȱŒ‘Š—Žœȱ
ȱ
ȱ

˜››Žœ™˜—’—ȱŠž‘˜›DZȱ Ž›–Š—Šȱǯȱ ›Ž˜›’˜ǰȱǰȱ‘ȱ

˜›ȱ Š‹—˜›–Š•’’Žœȱ ˜—ȱ ’–Š’—ȱ œž’Žœǰȱ Œ‘›˜—’Œȱ ™Š—Œ›ŽŠ’’œȱ ’œȱ
Ž™Š›–Ž—ȱ˜ȱŽ’Š›’Œœȱȱ Œ˜—œ’Ž›Žǯȱ ȱ Š’Ž—œȱ  ’‘ȱ –ž•’™•Žȱ Ž™’œ˜Žœȱ ˜›ȱ ›ŽŒž››Ž—ȱ
‘’•’™™’—Žȱ Ž—Ž›Š•ȱ
˜œ™’Š•ȱȱ ™Š—Œ›ŽŠ’’œȱ Ž›Žȱ˜—•¢ȱ›ŽŒ˜›Žȱ˜›ȱ‘Ž’›ȱ’—’’Š•ȱ™›ŽœŽ—Š’˜—ǯȱȱȱ
—’ŸŽ›œ’¢ȱ˜ȱ‘Žȱ‘’•’™™’—ŽœȱŠ—’•Šȱȱ
‘Žȱ ™Š’Ž—œȂȱ Œ•’—’ŒŠ•ȱ ŽŠž›Žœǰȱ ›ŽŠ–Ž—ȱ Š—ȱ ˜žŒ˜–Žȱ
ŠȱŸŽ—žŽǰȱ›–’ŠǰȱŠ—’•Šǰȱ‘’•’™™’—ŽœȱŗŖŖŖȱ
Ž•Ž™‘˜—ŽDZȱƸŜřŘȱśŘŜşŗŜŝȱ  Ž›Žȱ ›ŽŒ˜›Žȱ Š—ȱ Š—Š•¢£Žǯȱ ȱ ˜›”Ȭž™ȱ ˜›ȱ ‘Žȱ ™˜Ž—’Š•ȱ
–Š’•DZȱŽ›–Š—Šŗȓ‘˜–Š’•ǯŒ˜–ȱ Ž’˜•˜¢ȱ ˜ȱ ‘Žȱ ™Š—Œ›ŽŠ’’œȱ  Šœȱ Š•œ˜ȱ —˜Žȱ ’—ȱ ŽŠŒ‘ȱ ŒŠœŽǯȱ

VOL. 45 NO. 1 2011 ACTA MEDICA PHILIPPINA 13

Pancreatitis in Children

8 
 
 
3



 


0
0
E 
$'A  A

0
1.8I(*2
 






 
.4

 
0



 
  



@
 

/ 

  
"

 

 5
 




  
  
;
05 



  A

 


 
 @


 

 
 

  
3 

 0










?
0

  
 




 



  


3 

 


0


0

3 

 

@

  

 


 
3
  
 
3 

0
 4

  
/

 


0




 

3 

 


 
E

)%


  
 
    
3
3
 

3 


 

 



5

 
3

 

"

  


 
  
3



7


  
   



  
3 


 
3

  0
 

   


  
 


!
  

  
   


0
7





0
 /


3
  
;  


  


 


 
 
1(2

 
1)2


   


 
1)2


  
1$2
!3
  

"
 

)(
  
3
 



3
)$




/

 


0



7






3


 
  



  
  
 
     
E


  
3 
$)
1 
3

$B2
 
3

  
3



  


3
3


 
1*'C2
!
 9
1'$
C2
3

$%
 

  


 
 
  
0 






!3 
 
1+$C2
  
 

3

 

  


 


0
 
  

$+
3
 

 4

3
!


 
3 
 


3D 
3

 
 



3
  

 
0


7
  
1:
$2
3
 

D

9 



  
   
!


  
0

  



  

 
"

)$
  
3

0
 
 
3
  


   
E
  
0

3

  


 







  
0
162

 

  
1)2


3 

7 
   
!

  


 0

1)2
  
1$2


  
 

  
3 
 

0 


 


1$2





  


 




!



0

"
  
3
 

  
3
0



3 

  

  
E
 


 



 
  @


 




 





 


! 0
$


 
0
 
 


   







 
0  


 
   






     
 


 

)(


" 0
  
3 

 



  

  

3
  

 


 8

 

  


 
   





3 



0
 

/ 
  
162

!"!#
$# % $&% 
 
 
7
1)2

 


 '( ()* )+ 
 
1$2


?>




  

"0
 
 
$
,
$(
)$1+$2

 
)
'
$$
$+
1B(2


 
1$2
E 
  




  


" 7
%
(
*
B
1(*2

  
 
!

  

?

%
%
*
*
1)(2


#



    

< 
%
$
(
6
1$B2

F 

$
%
$
)
1+2

1#J2
3 
 
/


 
  

J
3 

 
%
$
%
$
162



0
  


1:
)2

:
%
$
%
$
162
3

#J
3


 


0
 




  




 
3 
 

1:
(2

!

  

  


 

3

3 
  
  

3
3@


(*$'
8GH
1 
$%B

*6,,6

),=$($2


$,%B
1 

!3 
 


)(
  
3

 


$6'

)B*)(
$%=))%
2
 




E 
  
3
  

3 


!
 
 
1+
 2


  



  

 





3

3 
7 

 /

 

  


3
 



  


 
 






"
 A  A



 
. 
0
1,
 
(%C2
3 
 
0




  
  



3



  
  
 
 



 
 
1(2
 
 


 
 



 
1)2


  

1)2
!3
 
 

  



0

 







  

A


  A


  
3




 

 
!

J

 

 
!
  
  
 
3



0 

 




  
3


  


0 


 
 94

0

A


0


 
!
  
3 
 



  


 
3
 

3


  


HA 
  
  



   
1
  


 0 


@ 24

  
3
 

3

 

14 ACTA MEDICA PHILIPPINA VOL. 45 NO. 1 2011

 Pancreatitis in Children



3
3


  

0






3


 


;



)(
 


)%%%

)%%6


)%%*

)%%+
!




  





3  



 
:



  
3
  



  


 

0
3
 




 

0

  



; 4

3



 

 
 




 


 







8
 
3
? >

+







 >
 

?  
3 @




0
 
 
3 



 
0







3
  
0
3 





  
!

 


$)A  A

 
3

5 
1+$C2




 

3




 

3
 
0
 
 


3


1'BC2
!


3 


 
3

  


!
 
3

 

 
3
  





7A  


0


 
0




"
J
3 
  

 


3


  
!
 

 
03
 






  
 

 



 
0 
 
0
3 







 

 


  
3 
 






3



? >


16*G$B%

)*C2
!



 


 




 




  


   



0 
 3





 
!
  





  
 
3
 
 



  
0
 

3
 
 




 

  
E
 


 



 




 



 

 


  




 



0


  
3 

 




 9


  
0
 



)%
 


3



 
  
   


  


  ,
J
 


$(A  A

 
3
 

  
E
7 


 
3


3
 
0
 
 
3 

 






$%
 

 
 
 

 
3
 


  
 




  

  









 


  



  
  



  
@

 
  
:
  



@
/

 


0




  
 
    
3

 

 


  
3

 

?


!



$)


  



3


 

  




 


 
J
3 




   

 

  
 

3

 

!

 


7 
3
5





 

0 
0 

7 

  

  



  

  

  

 


0



; 



0
<


"  $$



 


  



 
  
8


  -
#J
 
3 

 
 


 
3
0
 

 

 

 


3

  



 



  


  
!





 @ 3
    
7 




.   


  





 
E

!
 










 


 


 

0
 

: 




3
  


 
 

  

3


  
E 


3

 


 


,B

E

A  


 

 



3 

A0

VOL. 45 NO. 1 2011 ACTA MEDICA PHILIPPINA 15

Pancreatitis in Children

  

 
 





  4


A   



  








  



  @

  /




 

0



  




  $)



0
7


!
  






  


  

 4



///////////
   
!

  
3 

  

3


 

0


0 

 

  

$


H/
F
!
  
 
 


  


 



 




 
0 

  

 
3 
 A 

F

 
)%%)4$6%1*2'))=6


0 
 

3
A!.







  
)


.
!H

; 

. @




!
" 


  
!
0 
  


  
  


  


.
F
;
)%%B+*1$24'=)$

(


K/

! @

!
K 3 

L


F<

 




 








7  

  


  

  




   

  
  


  
F
 0 
  

;
)%%'4$(1$2)*=()


0
 


 
 

6


 


"




"
  

. 

  /

0$($6
<3 




 
 



 
;

F
;

)%%64+(1$2)+=((

8





 
0

*


H

M#


 

/
!
"
  
 

3 

 
 
1)'C2

 
3

: 
:
: 
 
$+,+4$,1)2$=$(




 

! 3


8

3


'



F
"




 A
 
 

































  


 
  
 

$+B)=$+B'
"

5 

)(


6$C
 $*$'


 






$++)4)B1)2$$)=)*

 /



  





0
,




F
J0
;#
 




  



 A /

0

  


 
# 
  
$+'(=+B

 0 



 
 


  







0

  


.


F
)%%64()B1,6*62$6''=+

B


#

8"
;@ 0
F
?
F


8 
 


 


:  
 


7
  
3

 

  

03
$+B*


$++*
;

F
  

5

 
   
!

 
 


)%%%4(*1$%2$$$%='

/

6

$)
(
"


  


+


?
;H
K  
;
: 
.
  


 
F


 
  
<
)%%(4(,1*2*+$=*

 


 

  




 
8

$%

;
?
8@
.




  
  



 
0


 

 
 


 A   



 
!


   
"
F

  
  


@

5
 
J  
$+B$4$(,1(26+,=*%)

$$

<

"
 
J
J 
J


  
 
 



   





  $,
?




  $%A  
7 


J 

 >
 

 

 A  


3

  
  
0 
F
  
 
)%%,))1B2$($(='


 4

 
0

  






$)

.

<
. 

J
83 
K


A





3


 @


 
  



  


 A0 

3

  
 

)%%,4*1'2'6B='$


?




 
   

3

$(

" 
J
 
 
;
F 

 

0

  


 



E 

0
 
 
  

 
  
8

F
!0
)%%B
E4**162)$6=
0 



 

 
  

  

 
'

 

,)



 
!
  

 
$6

 
;

""

;



  
0




  

.
)%%(4*1$26(=*

 


3
 


1$
G@G
2
 


 
$*

L 
L
H

 
:L


  


 AA7 

  


 

0

  
8
 
0
3
 
3
6(
 
#

F

 
$++'4$**1'26*B='(

  
 

3
   


 

$'

 
;
"
<K

K


  

 







8

 
 
8


 
)%%646$1,2,%6=$$

@

 
  


 
 

$,

!
;
 
!
H
"


  

 


 


  
3


  $B
3

7 
 

  
 


F

 
;

 


  0


  

)%%'46$1$$2$BB+=+(

  
  
8
 
0
 

 
  

$B


;

; 

. @



#  





@

 


 
  

  
3


  

0 
  
  


7

  

 A  


/

 
"
;



05 
0  
  
 
 

 
)%%B4$6(1$$2$$$$=,





 

 
  

 
$+

"
.F
H


K 
J:


# 
  

  

 0

  
3


  
 
3



  $+)%)$


7 

 


  
F
  
;

 $+++4(1(2)*)=')

 )%

<  
K
 
J
" 3 



#  

  

 
 0
 

  
3

  
"
F

8




0
 
 
3 



;
)%%'4$+)1$2)6=B




  
 



 
)$

?

F"
: 
K
J
F"


!




7



  
!

  


0
 





7

0




 


 






3
0
 
  


0 



 


  
.
F
;
$++(4B%1B2$%6)=
'




  
0 




 
;7
 




  




  0
 


  
"

  0

3 
0

# 

  


16 ACTA MEDICA PHILIPPINA VOL. 45 NO. 1 2011