• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.2 no.2
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• pp.194-203
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• 1999

Purpose: Childhood pancreatitis has more various and somewhat different etiology than adult. Until now the analysis of severity in childhood pancreatitis were not well-known, although several studies have been made. Therefore, we studied the etiology and complications in childhood pancreatitis and analyzed whether Ranson and CT criteria could be applicated to evaluate the severity of childhood pancreatitis patients. Methods: The records of 30 patients with pancreatitis under 15 years of ages who were diagnosed in Asan medical center were reviewed. Age, sex, history, etiology, clinical features and treatment was reviewed in all patients but complications, Ranson and CT criteria were available in only 12 patients. Correlation between the number of complications and both Ranson and CT criteria were calculated with Spearman correlation coefficient. Results: 1. Median age at diagnosis was 7.3 years of age. 28 cases were acute pancreatitis and 2 cases were chronic pancreatitis. 2. Etiology: choledochal cyst(8 cases), drug (7 cases), trauma (4 cases), infection (3 cases), biliary stone or bile sludge (3 cases), idiopathic (2 cases) Hemolytic uremic syndrome, pancreatic duct obstruction, iatrogenic (1 case). 3. Local complications were ascites (5 cases), pseudocyts (4 cases) and systemic complications were hyperglycemia (4 cases), hypocalcemia (3 cases), pleural effusion (3 cases), etc. 4. Positive correlation was found between the number of complication and Ranson creteria (r=0.78, P=0.0016) and between the number of complication and CT criteria (r=0.65, P=0.015) in 13 cases. Conclusion: A trial to search the biliary duct anomaly may help to find the causes of childhood idiopathic pancreatitis, and both Ranson and CT criteria can be applicated to pediatric patients to evaluate the severity of childhood pancreatitis.

• Journal of Veterinary Clinics
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• v.27 no.6
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• pp.686-692
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• 2010

Computed tomography (CT) is considered as gold standard in evaluating pancreatitis in human, but there have been only a few studies in veterinary field. Balthazar CT severity index (CTSI) used to assess the severity of acute necrotizing pancreatitis in human could be applicable to dogs, because the severity of acute pancreatitis depends on the area of pancreatic necrosis in dogs more than in human. In this study, 25 adult, clinically healthy beagle dogs were used. CT examinations was performed in normal pancreas, positive control group and acute necrotizing pancreatitis induced by autologous bile injection. Balthazar CTSI was applied to canine acute necrotizing pancreatitis in contrastenhanced CT image and compared with the result of histopathologic examination. The Hounsfield unit (HU) of normal canine pancreas was $52.44{\pm}4.58$ and the density was significantly decreased in acute necrotizing pancreatitis (P < .05). In contrast-enhanced CT examination, pancreatic density was decreased significantly and this area was compatible to pancreatic necrosis. Balthazar CTSI showed positive correlation with histopathologic evaluation with a sensitivity of 100% and a specificity of 88.89%. Balthazar CTSI can be applied to evaluate the severity of acute necrotizing pancreatitis in dogs.

• Clinical and Experimental Pediatrics
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• v.49 no.10
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• pp.1111-1115
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• 2006

Hereditary pancreatitis is an autosomal dominant disease characterized by recurrent episodes of pancreatitis, often beginning in childhood, with a positive family history involving at least two other affected family members with no known other precipitating factors. Most forms of hereditary pancreatitis are caused by one of two common mutations, i.e., R122H in exon 3 and N29I in exon 2 of the cationic trypsinogen (CT) (PRSS1) gene, located on chromosome 7. The authors describe the case of a 15-year-old boy who had suffered from recurrent attacks of pancreatitis since age three. His mother and grandmother had chronic pancreatitis and diabetes mellitus. Mutation analysis was performed on the family due to the suspicion of hereditary pancreatitis. The CT gene was analyzed in DNA samples extracted from the peripheral blood of three family members, the mother, the proband, and the proband's sister. Two members of the family, the mother and the proband, were found to have a N29I mutation in the CT gene. The authors document the first family with hereditary pancreatitis associated with the N29I mutation in Korea.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.1
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• pp.58-65
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• 2010

Purpose: Since there are few studies involving acute pancreatitis in children, we reviewed our experience with this medical condition to describe the clinical features. Methods: A retrospective analysis was conducted by reviewing the medical records of 41 patients with AP who were admitted to the Department of Pediatrics of Pusan National University Hospital between January 1996 and June 2007. Results: Twenty males and 21 females (mean age, 8.7${\pm}$4.5 years) were included. In 22 patients (53.7%), no definitive causes were found. The most common etiologies were choledochal cysts (22.0%). Necrotizing pancreatitis was diagnosed in 5 patients (12.2%), and recurrent acute pancreatitis in 4 patients (9.8%). CT findings included pancreatic swelling (43.9%), peripancreatic fluid collection (29.3%), ascites (24.4%), and peripancreatic fat necrosis (12.2%). Serum amylase and lipase levels at diagnosis were 535.3${\pm}$553.2 and 766.2${\pm}$723.6 U/L, respectively, and were normalized within 1 week in 22 and 14 patients, respectively. On the basis of the Balthazar scale, 2 patients were diagnosed with severe AP. In 4 patients (9.8%), a surgical procedure was indicated. Major complications included ascites (32.3%), sepsis (16.1%), and pseudocyst and renal impairments (12.9%). Two patients died from multi-organ failure. Conclusion: The etiologies of AP in children are varied. Most children have a single episode and a self-limited course. However, AP of childhood still carries significant morbidity and mortality. Early diagnosis, appropriate treatment according to disease severity, and management of complications are important.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.8 no.2
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• pp.275-278
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• 2005

We report a boy with acute pancreatitis without abdominal pain accompanied by hepatic hematoma and massive ascites due to unperceived trauma. The case was difficult to diagnose with image study and the level of amylase. Strong suspicion of pancreatic injury based on mechanism of injury and clinical evaluation would be required to avoid a delay in diagnosis.

• Tuberculosis and Respiratory Diseases
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• v.42 no.2
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• pp.226-230
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• 1995

Effusions arising from acute pancreatitis are usually small, left sided and self limiting. The incidence of pleural effusions in acute pancreatitis is reported between 3% and 17%. In chronic pancreatitis, as a consequence of fistula and pancreatitic pseudocyst formation or by spontaneous rupture of a pancreatic psudocyst directly into thoracic cavity, extremely large effusions may be seen. When the underlying pacreatic disease is asymptomatic, the diagnosis is made by measuring the amylase content of the pleural fluid. We experience a case of left sided pleural effusions caused by pancreatico-pleural fistula associated with pancreatic pseudocyst. The diagnosis was made by measuring of pleural fluid amylase level(80000U/L). Abdominal CT scan revealed pancreatic pseudocyct and pancreatitis with extension to left pleural space through esophageal hiatus and extension to left subdiaphragmatic space. Left pleural effusions were decreased after fasting, total parenteral nutrition and percutaneous pleural fluid catheter drainage. We reported a case of pleural effusions and pacreatico-pleural fistula asssociated with asymptomatic pancreatic disease with review of literatures.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.13 no.2
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• pp.204-209
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• 2010

Isolated pancreatic trauma and secondary obstructive jaundice in the pediatric population is unusual. Biliary tract obstruction can be a major cause of acute pancreatitis. We report a case of obstructive jaundice secondary to isolated traumatic acute pancreatitis in a previously healthy 32-month-old girl. In our case, secondary obstructive jaundice aggravated the pancreatic inflammation and was successfully treated with percutaneous transhepatic biliary drainage (PTBD).

• Pediatric Infection and Vaccine
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• v.30 no.2
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• pp.104-110
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• 2023

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) mainly causes respiratory symptoms such as fever, cough, sputum, and rhinorrhea, as well as digestive symptoms such as diarrhea, vomiting, and abdominal pain in children. In this report, we describe a case of a child with a SARS-CoV-2 infection who presented with epigastric pain and was subsequently diagnosed with acute pancreatitis without any concomitant infections in other organs. The epigastric pain was relieved with goal-directed vigorous fluid therapy for acute pancreatitis for 24 hours, and the serological and radiological findings normalized after two months. Acute pancreatitis should be considered as a differential diagnosis when a child with a history of COVID-19 visits the hospital with epigastric pain.

• Advances in pediatric surgery
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• v.12 no.1
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• pp.24-31
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• 2006

Hereditary pancreatitis (HP) appears as an autosomal dominant trait. If the patient has (1) more than 2 affected relatives in different generations and (2) no known etiological factors such as alcohol or gallstones, or has R122H or N29I mutation in the cationic trypsinogen (CT) gene, the diagnosis of HP can be applied. Risk of pancreatic cancer is estimated to be 53-fold higher than in a general population after the age of 50 years. We report a kindredof HP, involving three of its family together; two siblings (14 years old, 13 years old) and cousin (26 years old). The patient had complicating chronic pancreatitis and pancreatic stone, and was treated with amodified Puestow-Gillesby procedure. Her sisters showed chronic pancreatitis. Her cousin underwent a drainage procedure of the pancreatic duct for chronic pancreatitis during the high school period. All the three members showed the R122H mutation of the CT gene.

• The Korean Journal of Medicine
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• v.93 no.6
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• pp.560-564
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• 2018

Autoimmune pancreatitis (AIP) is rarely associated with pancreatic pseudocysts. AIP-associated pseudocysts requiring drainage despite steroid therapy are rather rare. We report a case of AIP with an infected pseudocyst requiring drainage despite steroid therapy. A 68-year-old male was diagnosed with AIP via pancreatic imaging, a high serum immunoglobulin G4 level, and steroid responsiveness. The AIP was accompanied by a pancreatic pseudocyst. Steroid therapy was prescribed, but the pancreatic pseudocyst became aggravated during steroid tapering. Endoscopic ultrasonography-guided cyst drainage was required; the pseudocyst then became completely resolved.