scholarly journals Childhood Pancreatitis: A Case Series

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Hamzah Sukiman ◽  
Mohd Latiff Iqramie Muhamad Zaki ◽  
Mohd Fauzi Sharudin ◽  
Mohd Arief Md Sobri
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Rural Communities ◽  
Pancreatic Pseudocyst ◽  
Serum Amylase ◽  
Clinical Course ◽  
Demographic Data ◽  
Case Series ◽  
Local Data ◽  
Course Of Disease

Introduction: Acute pancreatitis is relatively rare in children. Published local data on childhood pancreatitis is even vanishingly scarce. Our intent is to evaluate the demography, aetiology, clinical course, and complications of children with acute pancreatitis. Materials and Methods: A singlecentre, retrospective review of patients aged 12 years or younger, admitted between January 2016 to February 2018 with the diagnosis of acute pancreatitis performed. Demographic data, aetiology, and serum amylase on admission were collected. DeBanto score for assessment of severity was calculated (at admission and at 48H) and patients’ clinical outcome was assessed. Results: A total of eight patients, aged between 3 to 12 years (median 8.0 years) were diagnosed with acute pancreatitis. Malays made up the majority (50%) but the Orang Asli is over-represented at 37.5%. Most were idiopathic (50%), but 25% of pancreatitis were caused by helminths. All patients presented with abdominal pain as the primary complaint. Most of them followed a mild course of disease; all but one patient had a DeBanto score of <3. Mean length of stay was 5 days, and two patients went on to develop complications (pancreatic pseudocyst and recurrent pancreatitis). Conclusion: Acute pancreatitis remains an important diagnosis for children presenting with abdominal pain. In addition to commonly described aetiologies, helminthic infestation is an important cause of acute pancreatitis, especially among rural communities in the state of Pahang.

scholarly journals Acute Pancreatitis: An Atypical Presentation

2017 ◽  
Vol 11 (2) ◽  
pp. 359-363 ◽  
Author(s):  
Omar Nadhem ◽  
Omar Salh
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Reports ◽  
Case Series ◽  
Normal Serum ◽  
Intravenous Fluids ◽  
Serum Enzyme ◽  
Serum Lipase ◽  
Upper Abdominal ◽  
Symptoms And Signs

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

Acute pancreatitis

2010 ◽  
pp. 2557-2567
Author(s):  
R. Carter ◽  
C.J. McKay
Keyword(s):  
Acute Pancreatitis ◽  
Peptic Ulcer ◽  
Gastric Ulcer ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Perforated Peptic Ulcer ◽  
Upper Limit ◽  
Abdominal Emergencies ◽  
Idiopathic Acute Pancreatitis ◽  
Upper Abdominal

Acute pancreatitis affects 300 to 600 new patients per million population per year and is most commonly caused by gallstones or alcohol, but there are many other causes and associations. Careful imaging reveals that most so-called idiopathic acute pancreatitis is due to small (1–3 mm diameter) gallstones. Diagnosis is made by a combination of a typical presentation (upper abdominal pain and vomiting) in conjunction with raised serum amylase (> × 3 upper limit of normal) and/or lipase (> × 2 upper limit of normal). Several acute abdominal emergencies can mimic acute pancreatitis and may be associated with a raised serum amylase. These include perforated peptic ulcer (particularly perforated posterior gastric ulcer) and acute mesenteric ischaemia. In equivocal cases, a CT scan is indicated in order to exclude other causes and confirm the diagnosis....

scholarly journals Hypothermia and Acute Pancreatitis: Myth or Reality?

2003 ◽  
Vol 96 (5) ◽  
pp. 228-229 ◽  
Author(s):  
Rh E Stiff ◽  
Gj Morris-Stiff ◽  
J Torkington
Keyword(s):  
Acute Pancreatitis ◽  
Risk Factor ◽  
Abdominal Pain ◽  
Dual Diagnosis ◽  
Cerebrovascular Accident ◽  
Serum Amylase ◽  
Response Rate ◽  
Emergency Admissions ◽  
Weak Evidence ◽  
Relevant Risk Factor

Among the rarer causes of acute pancreatitis listed in surgical texts is hypothermia. To assess the evidence for cause and effect, we questioned selected consultants about their experience and examined the case-notes of patients admitted with hypothermia. The 31 consultants who returned our questionnaire (69% response rate; 317 consultant-years’ experience) could recall only 5 cases of pancreatitis associated with hypothermia, in 2 of which other aetiological factors were judged primary. In case-notes for 100 months of emergency admissions at a single hospital we identified 310 patients with hypothermia and 1153 with acute pancreatitis; none had the dual diagnosis. Of the hypothermic patients, none had abdominal pain typical of acute pancreatitis. In 43 serum amylase was measured because the patient was unable to give a full history and in 2 of these the enzyme was slightly raised; both had experienced a cerebrovascular accident, which is a known cause of hyperamylasaemia. Considered alongside the weak evidence from previous studies, these findings offer negligible support for the idea that hypothermia is a clinically relevant risk factor for acute pancreatitis.

scholarly journals SAT-579 Experiences with Hypertriglyceridemic Pancreatitis: A Mini Case Series

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Priyanka Majety ◽  
Richard D Siegel
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Early Recognition ◽  
Rare Complication ◽  
Case Series ◽  
Diagnostic Challenge ◽  
Eruptive Xanthomas ◽  
History Of ◽  
Appropriate Therapy ◽  
Pruritic Skin

Abstract Background: Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP) in up to 14% of all cases & up to 56% cases during pregnancy. The triad of HTG, Diabetic ketoacidosis (DKA) and AP is rarely seen posing diagnostic challenges. Early recognition of HTG-induced pancreatitis (HTGP) is important to provide appropriate therapy & prevent recurrence. In this case series, we discuss the diagnostic challenges and clinical features of HTGP. Clinical cases: Our first patient was a 65-year-old male with a history of hypertension who presented to the ER with abdominal pain and new-onset pruritic skin rash after a heavy meal. His exam and labs were notable for a diffuse papular rash on his back, triglycerides (TG) of 7073mg/dL (normal: &lt;150mg/dL). The rash improved with the resolution of HTG. Our second patient was a 29-year-old male with a history of alcohol dependence who was found to have AP complicated by ARDS requiring intubation. Further testing revealed that his TG was 12,862mg/dL & his sodium (Na) was 102mEq/L. Although HTG was known to cause pseudohyponatremia, it was a diagnostic challenge to estimate the true Na level. In a third scenario, a 28-year-old female with a history of T2DM on Insulin presented with nausea & abdominal pain. Labs were suggestive of DKA and lipase was normal. CT abdomen showed changes consistent with AP. The TG level that was later added on was elevated to 4413mg/dL. She was treated with insulin that improved her TG level. Discussion: We present three cases of hypertriglyceridemic pancreatitis. While the presentation can be similar to other causes of acute pancreatitis (AP), there are factors in the diagnosis and management of HTGP that are important to understand. Occasionally, physical exam findings can be suggestive of underlying HTG. In the first scenario, our patient presented with eruptive xanthomas - a sudden eruption of crops of papules that can be pruritic. They are highly suggestive of HTG, often associated with serum TG levels &gt; 1500mg/dL. Our second patient presented with pseudohyponatremia. HTG falsely lowers Na level, by affecting the percentage of water in plasma. Identifying this condition is important to prevent possible complications from aggressive treatment. This can be corrected either by using direct ion-specific electrodes or with the formula: Na change = TG * 0.002. DKA is associated with mild-moderate HTG in 30–50% cases. This is due to insulin deficiency causing activation of lipolysis in adipocytes & decreased activity of lipoprotein lipase (LPL). However, severe HTG is a rare complication of DKA, increasing the risk of AP. Diagnosis of AP in DKA poses many challenges: the common presenting complaint of abdominal pain, non-specific hyperlipasemia in DKA. AP with DKA has also been associated with normal lipase levels. A high clinical index of suspicion is required to diagnose HTGP in patients with DKA.

scholarly journals Chemical peritonitis associated with intraperitoneal vancomycin: A case series

2021 ◽  
Vol 35 (2) ◽  
Author(s):  
José Silvano ◽  
◽  
Luciano Pereira ◽  
Ana Oliveira ◽  
Ana Beco ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Drug Withdrawal ◽  
Clinical Course ◽  
Leukocyte Count ◽  
Case Series ◽  
Aseptic Technique ◽  
Drug Challenge ◽  
Chemical Peritonitis ◽  
Culture Negative

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.

Frequency of Left Plueral Effusion in Acute Necrotizing Pancreatitis

2021 ◽  
Vol 15 (10) ◽  
pp. 3349-3351
Author(s):  
Hunain . ◽  
Farah Saleem ◽  
Muhammad Waqas Arshad ◽  
Kauser Shaikh ◽  
Mamoona Shaikh ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Pleural Effusion ◽  
Serum Amylase ◽  
Necrotizing Pancreatitis ◽  
Case Series ◽  
Acute Necrotizing Pancreatitis ◽  
Amylase Level ◽  
X Ray ◽  
Left Pleural Effusion ◽  
Acute Necrotizing

Objective: The aim of this study is to calculate the prevalence of left plueral effusion in acute necrotizing pancreatitis. Study Design: Observational/ case series Place and Duration: Conducted at surgery department of Saidu Teaching Hospital, Swat and Ibne Sina Hospital and Research Institute, Multan for duration of six months from January 2021 to June 2021. Methods: A total of 95 patients, both males and females, ranging in age from 15 to 65 years, were presented. After receiving informed written consent, the baseline comprehensive demographics of the patients presented were recorded, including age, gender, and body mass index. Patients with acute pancreatitis and serum amylase levels greater than 300U/dL were eligible to participate. Patients were subjected to X-ray and CT scans in their entirety. Prevalence of necrotizing pancreatitis was calculated by CT scan and for left plueral effusion X-ray of chest was taken. SPSS 24.0 version was used to analyze complete data. Results: Majority of the patients 65 (68.4%) were females and 30 (31.6%) were males with mean age 39.14+5.67 years. 26 (27.4%) cases had BMI less than 20kg/m2 and the majority were >20kg/m2. Gallstone was the most common cause of acute pancreatitis found in 45 (47.4%) cases, followed by alcoholism 25 (26.3%) and medications 12 (12.6%). Among 95 cases, prevalence of necrotizing pancreatitis was 42 (44.2%) in which 40 cases had left plueral effusion. Mortality rate among necrotizing pancreatitis was 13 (33.3%). Conclusion: We found that the majority of individuals with necrotizing pancreatitis experienced pleural effusion on the left side. Thus, patients with acute pancreatitis who have a high serum amylase level must be treated earlier if they have a left pleural effusion because of severity. Keywords: Plueral Effusion, Acute Necrotizing Pancreatitis, Mortality

scholarly journals Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

2017 ◽  
Vol 40 (3) ◽  
pp. 160-165
Author(s):  
Nadira Musabbir ◽  
ASM Bazlul Karim ◽  
Md Wahiduzzaman Mazumder ◽  
Kaniz Sultana ◽  
Syeda Afria Anwar ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Abdominal Mass ◽  
Elevated Serum ◽  
Clinical Feature ◽  
Cross Sectional ◽  
Female Ratio ◽  
Epigastric Region ◽  
Common Location

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

scholarly journals Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Tiffany J. Patton ◽  
Timothy A. Sentongo ◽  
Grace Z. Mak ◽  
Stacy A. Kahn
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Severe Acute Pancreatitis ◽  
Pancreatic Pseudocyst ◽  
Fluid Collection ◽  
Initial Presentation ◽  
Metabolic Abnormalities ◽  
Pediatric Case ◽  
Severe Pancreatitis ◽  
Colonic Necrosis

Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis.

scholarly journals A Rare Case Report of Pseudo Pancreatic Cyst in a Child

2021 ◽  
Vol 10 (31) ◽  
pp. 2535-2537
Author(s):  
Syed Athhar Saqqaf ◽  
Amar Taksande ◽  
Revat Meshram
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Report ◽  
World Literature ◽  
Pancreatic Pseudocyst ◽  
Fibrous Tissue ◽  
Previous History ◽  
Pancreatic Cysts ◽  
Serum Lipase ◽  
History Of

It is difficult to diagnose pancreatic cysts in children. Any previous history of acute pancreatitis is very important because it can lead to a wide set of complications like pseudocyst, pancreatic necrosis, splenic venous thrombosis etc. The most known and common cause of pancreatic pseudocyst in children is trauma. The characteristic features of pancreatitis include abdominal pain, serum lipase or amylase values three times more than that of the normal range and characteristic radiological features. Pancreatic pseudocyst may occur in 15 % of children with acute pancreatitis as a complication.1 Pancreatic juice collection enclosed by a wall of granulation or fibrous tissue, is defined as a pseudocyst. As the resulting cyst has no true endothelial lining, it is classified as a pseudocyst.2 The pseudocyst contains inflammatory pancreatic fluid, mainly the lipase enzyme or semisolid matter. The incidence of pseudocyst is relatively low 1.6 % - 4.5 %, or 0.5 - 1 per 100 000 adults per year.2 Very few cases of pancreatic pseudocyst have been reported in world literature. Commonly, it develops as a sequel of acute or chronic pancreatitis. It develops around 4 weeks after the episode of acute pancreatitis.3 It is characterized by pancreatic inflammation, abdominal pain and raised levels of serum digestive enzymes.4 Here we discuss a case report of pancreatic pseudocyst in a 10-year-old male child presenting with history of abdominal pain and decreased appetite.

scholarly journals The Role of Routine Assays of Serum Amylase and Lipase for the Diagnosis of Acute Abdominal Pain

2009 ◽  
Vol 91 (5) ◽  
pp. 381-384 ◽  
Author(s):  
Paul A Sutton ◽  
David J Humes ◽  
Gemma Purcell ◽  
Janette K Smith ◽  
Frances Whiting ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Serum Amylase ◽  
Reference Range ◽  
Acute Abdominal Pain ◽  
Clinical Suspicion ◽  
University Teaching ◽  
Data Set ◽  
Serum Lipase

INTRODUCTION We aimed to evaluate the role of routine measurements of serum amylase and lipase in the diagnosis of acute abdominal pain. PATIENTS AND METHODS We identified all patients who had serum amylase and lipase assays over a 62-day period at a single university teaching hospital and reviewed their case notes. RESULTS We excluded 58 of the 1598 patients on grounds of ineligibility (< 18 years of age and those transferred from other hospitals). A complete data set was obtained for 1520 (98.7%) of the remaining 1540 patients. Only 9.1% of requests were based on a clinical suspicion of acute pancreatitis. Of the 44 (2.9%) patients who had acute pancreatitis, only 28 (63.6%) had an associated rise in serum amylase and/or lipase 3 times above the maximum reference range, the remainder being diagnosed radiologically. At this cut-off range, the sensitivity and specificity for serum amylase were 50% and 99%, and those for serum lipase 64% and 97%, respectively. CONCLUSIONS Routine measurements of serum amylase and lipase are unhelpful in the diagnosis of acute abdominal pain unless there is clinical suspicion of acute pancreatitis. In these patients, assay of lipase alone is preferable to assay of amylase alone or both enzymes.

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