Chapter 31

Inflammatory disorders of the pancreas are classified as acute or chronic. Acute pancreatitis is generally a reversible process with no significant permanent effects on pancreatic histology or function, whereas chronic pancreatitis leads to irreversible changes in the architecture and function of the pancreas. Both are defined clinically. Acute pancreatitis is a distinct event requiring two of the following three features for diagnosis: (1) clinical symptoms consistent with acute pancreatitis, (2) serum amylase or lipase levels or both at least three times the upper limit of normal, and (3) findings of acute pancreatitis on transabdominal ultrasonography or on contrast-enhanced computed tomography (CECT). Chronic pancreatitis is a progressive disease leading to typical histological and morphological changes in the pancreas, usually identified by radiographic methods, or to loss of digestive function or both.

Acute Pancreatitis

The diagnosis of acute pancreatitis in childhood has increased over the years.1,2 Currently, the incidence in large children’s hospitals may approach 12–15 cases per 100,000 children per year. The reason for the increase remains unsettled, but a recent study suggested that increased awareness of the disease in childhood is the major factor, since increased amylase and lipase testing accounted for the majority of the change at a single institution.

Although a wide range of prevalence in etiologies exists among various reports and the categories often vary among the reports, systemic illness, biliary disease, trauma, and side effects of medications comprise the majority of patients with an identifiable etiology (Table 31–1).3 A sizable portion of patients have no discerned etiology and are classified as idiopathic. Since there is wide variation in prevalence of etiologies among the available reports, any current compilation of these requires some ambiguity in categorization. The overall variation likely reflects the retrospective nature of the studies, the bias or experience of the clinicians, incomplete investigations for etiologies in many patients, and the recognition of new etiologies over time.

Table 31–1. Etiologies of Acute Pancreatitis

Recurrent episodes of acute pancreatitis occur in about 10% of children. The most common etiologies in these patients are structural abnormalities, ...

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