Childhood pancreatitis with biliary calcareous disease

Pancreatitis in teenagers

Pancreatitis in teenagers is rare and has not received attention in the medical literature. A retrospective study was conducted to identify unique factors in this age group. Clinical data, cause, radiographic evaluation, operative procedure, and outcome were reviewed in 21 teenagers. Endoscopic retrograde cholangiopancreatography and computerized axial tomography proved to be valuable in determining the etiology and the role and type of operation. Causes of disease were varied but were established in 86 percent of patients; as a group, teenagers were unlike children or adults in their disease characteristics. A high percentage of teenagers required operation (76 percent), with most benefiting from surgery (88 percent).

Pediatric hepatobiliary disease

The surgical aspects of pediatric hepatobiliary disease concern a unique set of diagnoses, disease processes, diagnostic issues, and treatment problems. In this context, this article discusses features of biliary atresia, choledochal cyst, gallbladder disease, and liver abscess in the infant, child, and adolescent.

Choledocholithiasis in infancy

Three cases of choledocholithiasis presenting with obstructive jaundice in infancy are reported. Ultrasonography demonstrated a grossly dilated common bile duct in all three cases. It failed, however, to demonstrate the calculi that were situated at the distal end of the common duct. Percutaneous transhepatic cholangiography was valuable in one patient in outlining the biliary tract and in identifying the cause of the obstruction. Endoscopic retrograde cholangiopancreatography (ERCP) was employed in a child, aged three years, in whom it was possible to proceed to endoscopic sphincterotomy with clearance of the common duct. In small infants, transduodenal sphincteroplasty would appear to be the procedure of choice.

Relapsing acute and chronic pancreatitis

Twenty five children with non-traumatic relapsing acute or chronic pancreatitis who had been followed up from five months to seven years were studied. Seven had congenital anomalies, including two with choledochal cysts and four with pancreas divisum. Alcohol related disease was suspected in one child. The importance of diabetes in two patients and a positive family history in a further three is discussed, but in 12 children no association was found. Management was similar to that for adults. Surgical intervention was required in six patients, and percutaneous drainage of pseudocysts in a further three. Outcome has generally been good.