• 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.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.

• Advances in pediatric surgery
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• v.2 no.1
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• pp.17-25
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• 1996

Acute pancreatitis(AP) in children is not common but can be associated with severe morbidity rates and its diagnosis is often delayed. Thus, reported mortality rates range from 0 to 78%. We have treated 26 patients with AP from 5 to 17 years of age over the past 17 years. We are intended to assess the relevance of the prognostic criteria used to assess severity of adult AP and to review the etiology, clilical presentation, diagnosis, and management of AP in children. The authors retrospectively reviewed 26 children with AP managed in Kyung Hee University Hospital from 1978 to 1995. Among 26 patients with AP, male were 12, and female were 14. And the mean age of patients was 11.8 years. In 9(34.6%), no definitive cause was identified. Common causes of AP were trauma(23.1%) and biliary tract disease(23.1%). Other etiologies were viral infection(15.4%) and post ERCP(3.8%). The presenting features were abdominal pain(92.3%), vomiting(61.5%), fever(19.2%), submandibular pain(11.5%), and abdominal mass(7.6%). Back pain was rare(3.8%). Abdominal ultrasonographic findings were abnormal in 10 of 16 patients(62.5%) and abdominal CT findings were abnormal for 9 of 9 patients(100%). Seventeen patients(65.3%) were managed conservatively, and nine patients(34.6%) required surgical treatment. There was no mortality. To evaluate the severity of disease, we used the Imrie prognostic criteria used to assess the severity in adult AP. The number of positive criteria was correlated to the duration of hospitalization(r2=0.91) but statistically insignificant(p>0.05). But, the number of positive criteria was correlated to the operative incidence(r2=0.93) and statistically significant(p<0.05). The common causes of AP in children were unknown origin(34.6%), trauma(23.1%), and biliary tract disease(23.1%). Ultrasonography and computed tomography were useful imaging tools of AP in children. The Imrie criteria used to evaluate the severity in adult AP were suspected to be valuable to assess the severity of AP in children.

• The Journal of Internal Korean Medicine
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• v.41 no.3
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• pp.306-325
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• 2020

Objectives: The aim of this study is to investigate the effect of a Dachaihu decoction for hyperlipidemic acute pancreatitis (HLAP) by systematic review and meta-analysis of Chinese clinical studies. Methods: China National Knowledge Infrastructure (CNKI) was utilized as the major search engine. The date of the literature search was March 7, 2020. Randomized controlled trials (RCTs) about using a Dachaihu decoction for HLAP were included in this study. Meta-analysis was performed by synthesizing outcome data, including total effective rate, abdomen pain relief time, first bowel movement time, blood amylase recovery time, and triglyceride (TG) levels (mmol/L). The selected literature was assessed using Cochrane's risk of bias (RoB). Results: Twelve of 44 RCTs met the inclusion criteria. Most studies were evaluated with RoB as having unclear risk. The total effective rate of herbal medicine treatment based on the Dachaihu decoction was significantly higher than that of symptomatic supportive treatment in 10 articles (risk ratio=1.15, 95% CI: 1.08 to 1.21, p<0.00001, I²=0%). Herbal medicine treatment based on a Dachaihu decoction was significantly more effective than symptomatic supportive treatment in terms of reducing abdomen pain relief time (in all articles; mean difference=-1.70, 95% CI: -1.91 to -1.41, p<0.00001, I²=45%), first bowel movement time (in 7 articles; mean difference=-1.46, 95% CI: -1.86 to -1.05, p<0.00001, I²=73%), blood amylase recovery time (in 8 articles; mean difference=-1.48, 95% CI: -2.04 to -0.92, p<0.00001, I²=90%), and TG levels (in 8 articles; mean difference=-1.59, 95% CI: -2.28to -0.91, p<0.00001, I²=90%). Only one article reported side effects of treatment among the intervention group and control group, citing pancreatic ulcer and pancreatic pseudocyst formation. Conclusions: This study suggests that herbal medicine treatment based on a Dachaihu decoction could yield higher efficacy for HLAP than symptomatic supportive treatment alone. However, the results might be somewhat biased because of the poor quality and small sample size of the included RCTs. Well-qualified clinical studies are needed to prove the effectiveness of Dachaihu decoction therapy for HLAP.

• The Korea Journal of Herbology
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• v.34 no.1
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• pp.75-80
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• 2019

Objectives : Dictamni Radicis Cortex (DRC) has been used as an important traditional medicine for inflammation and fungal diseases. However, the protective effect of DRC water extract on acute pancreatitis (AP) has not been deeply reported. Therefore, we aimed to evaluate the protective effects of DRC water extract on cerulein-induced AP. Methods : AP was induced via intraperitoneal injection of supramaximal concentrations of stable cholecystokinin analogue cerulein ($50{\mu}g/kg$) every hour for 6 times. DRC water extract (0.05, 0.1, or 0.2 g/kg) or saline was administrated intraperitoneally 1 h before to the first injection of cerulein. The mice were sacrificed at 6 h after the final cerulein injection. Pancreas was rapidly removed for histochemical examination and myeloperoxidase (MPO) assay. In addition, polymerase chain reaction (PCR) was performed to examine mRNA levels of proinflammatory cytokines such as Interleukin $(IL)-1{\beta}$, IL-6 and Tumor necrosis factor $(TNF)-{\alpha}$. Results : Administration of DRC water extract significantly inhibited the pancreatic weight to body weight ratio, pancreas histological damages and increase of pancreatic MPO activity during cerulein-induced AP. In addition, increased pancreatic mRNA levels of $IL-1{\beta}$, IL-6 but not $TNF-{\alpha}$ were significantly inhibited by treatment of DRC water extract against cerulein-induced AP. Conclusions : In conclusion, we have revealed that pre-treatment of DRC water extract reduces the severity of cerulein-induced AP. Accordingly, our results could give a clinical basis that DRC could be used as a drug or agent to prevent AP.

• Archives of Craniofacial Surgery
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• v.18 no.4
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• pp.261-263
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• 2017

Anisakis is a parasite with life cycles involving fish and marine mammals. Human infection, anisakiasis, occurs with the ingestion of raw infected seafood and usually presents with acute or chronic gastrointestinal symptoms from esophageal or gastric invasion. We report a rare caseinvolving the oral cavity. A 39-year-old male presented with oral and sub-sternal pain of one day duration after eating raw cuttlefish. Physical examination revealed areas of erythema and edema with a central white foreign particle on the labial and buccal mucosa. With microscopic field we could remove the foreign material from the lesions. The foreign material was confirmed to be Anisakis. Anisakis was also removed from the esophagus by esophagogastroduodenoscopy. The patient was discharged the following day without complication. Anisakiasis is frequently reported in Korea and Japan, countries where raw seafood ingestion is popular. The symptoms of acute anisakiasis include pain, nausea, and vomiting and usually begin 2-12 hours after ingestion. The differential diagnosis includes food poisoning, acute gastritis, and acute pancreatitis. A history of raw seafood ingestion is important to the diagnosis of anisakiasis. Treatment is complete removal of the Anisakis to relieve acute symptoms and prevent chronic granulomatous inflammation.

• Proceedings of the Korean Society of Veterinary Clinics Conference
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• 2006.05a
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• pp.177-177
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• 2006

• Proceedings of the Korean Biophysical Society Conference
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• 2002.06b
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• pp.24-24
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• 2002

The mechanism of how cholelithiasis increases the risk of acute pancreatitis remains obscure. When gallstones obstruct the lower biliary tract, bile acids can enter the pancreas either by luminal diffusion or by interstitial leakage. Here we provide the first evidence that bile acids can be transported into pancreatic acinar cells through the membrane transporters and induce cell death by impairing intracellular Ca$\^$2+/ signals.(omitted)

• Journal of The Korean Society of Clinical Toxicology
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• v.15 no.1
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• pp.56-59
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• 2017

Pneumatosis cystoides intestinalis and portomesenteric venous gas are uncommon radiological findings, but are found commonly in cases of bowel ischemia, or as a result of various non-ischemic conditions. A 72-year-old man visited an emergency center with altered mental status 2 hours after ingestion of an unknown pesticide. On physical examination, he showed the characteristic hydrocarbon or garlic-like odor, miotic pupils with no response to light, rhinorrhea, shallow respiration, bronchorrhea, and sweating over his face, chest and abdomen. Laboratory results revealed decreased serum cholinesterase, as well as elevated amylase and lipase level. We made the clinical diagnosis of organophosphate poisoning in this patient based on the clinical features, duration of symptoms and signs, and level of serum cholinesterase. Activated charcoal, fluid, and antidotes were administered after gastric lavage. A computerized tomography scan of the abdomen with intravenous contrast showed acute pancreatitis, poor enhancement of the small bowel, pneumatosis cystoides intestinalis, portomesenteric venous gas and ascites. Emergent laparotomy could not be performed because of his poor physical condition and refusal of treatment by his family. The possible mechanisms were believed to be direct intestinal mucosal damage by pancreatic enzymes and secondary mucosal disruption due to bowel ischemia caused by shock and the use of inotropics. Physicians should be warned about the possibility of pneumatosis cystoides intestinalis and portomesenteric venous gas as a complication of pancreatitis following anticholinesterase poisoning.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.23 no.1
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• pp.105-109
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• 2020

The incidence of acute pancreatitis (AP) has increased in the pediatric population over the past few decades and it stands to follow that the complications of severe AP, including symptomatic pancreatic fluid collections (PFCs) will increase as well. In adults, the therapeutic options for this situation have undergone a dramatic evolution from mainly surgical approaches to less invasive endoscopic approaches, mainly endoscopic ultrasound-guided transmural drainage (EUS-TD) followed be direct endoscopic necrosectomy if needed. This has proven safe and effective in adults; however, this approach has not been well studied or reported in pediatric populations. Here we demonstrate that EUS-TD seems to offer a safe, efficacious and minimally invasive approach to the management of large PFCs in pediatric patients by reviewing two representative cases at our institution.