Surgical therapy and follow-up of pancreatitis in children

Background: Acute and chronic pancreatitis in children differ from that in adults both from the etiology and the therapeutic approach. Within the frame of a blunt abdominal trauma-the most frequent cause in children-acute pancreatitis is often detected by emergency laparotomy and external drainage is recommended. Chronic relapsing pancreatitis, and particularly its hereditary form, is very rare in children and requires a different therapeutic concept. The results of surgical therapy for both forms of pancreatitis in childhood were evaluated in the present study. Methods: Sixteen patients with acute and chronic relapsing pancreatitis were operated on in our facility between 1976 and 1988. Their history and postoperative course were analyzed in a retrospective study, including a final examination at the end of the follow-up period. Results: Eight children with acute pancreatitis were operated on at an average age of 6 years and were followed up for an average of 7.5 years, with good results. The remaining children, aged between 3 and 14 years (average age of 9 years), were operated on for chronic relapsing pancreatitis. Our experience with early operative treatment, on average 2.7 years after onset of symptoms, is presented. Only three patients experienced a mild relapse during the follow-up period of 2-13 years (average of 5.4 years). Conclusions: For acute pancreatitis in childhood, operative treatment by inner drainage is necessary and effective only in case of complications, should conservative treatment fail. In children with chronic relapsing pancreatitis, the good exocrine and the normal endocrine function of the pancreas in these patients justified the early operation. Timely treatment is recommended in cases with typical changes of the pancreatic duct so as to shorten the relapsing clinical problems of the children and to maintain the function of the pancreas.