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