Ayşegul BÜKÜLMEZ, Çigdem ÖZER GÖKASLAN, Pelin BALIKOĞLU, Ayşe Tolunay OFLU

Çocuklarda Pankreatit: Tek Merkez Deneyimi

Amaç: Bu çalışmada akut pankreatit, akut rekürren pankreatit ve kronik pankreatit tanısı ile izlenen çocukların klinik, laboratuvar ve etiyolojik farklılıklarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Ocak 2014-Aralık 2017 tarihleri arasında pankreatit tanısı ile izlenen çocukların tıbbi kayıtları retrospektif olarak değerlendirilmiştir. Çalışmamıza Afyonkarahisar Sağlık Bilimleri Üniversitesi Tıp Fakültesi Etik Kurulu’ndan onay alınmıştır. Olgularımız INSPPIRE grubu tanımlamalarına göre akut pankreatit, akut rekürren pankreatit ve kronik pankretit olarak sınıflandırılmıştır. Akut pankreatit (grup 1) ve akut rekürren ve kronik pankreatit (grup 2) grupları arasında etiyoloji, demografik özellikler, laboratuvar ve radyolojik bulgular karşılaştırılmıştır. Bulgular: Akut pankreatit grubunda (grup 1) 43 hasta (%78,2) mevcuttur. Grup 2; akut rekürren pankreatit tanısı alan 8 olgu ve kronik pankreatit tanısı ile izlenen 4 olgu içermektedir [toplam 12 olgu (%21,8)]. Olgularımızın etiyolojisine bakıldığında grup 1’de idiyopatik (%88,5), taş(%2,3), travma(%2,3) ve enfeksiyonlar (%4,6),koledok kisti (%2,3); grup 2 de ise idiyopatik (%50), pankreatik kanalın konjenital anomalileri (%8,3), alerji (%8,3), otoimmünite (%8,3) ve genetik sebeplerdir (%25). Her iki grup arasında laboratuvar değerleri açısından istatistiksel bir fark bulunmamıştır. Sonuç: Çalışmamızda tüm gruplarda genellikle pankreatitin nedeni tanımlanamamıştır. Akut pankreatit olgularında etiyolojide ikinci sırada enfeksiyonlar mevcut olup, akut rekürren ve kronik pankreatitte sık görülen nedenler genetik sebepler olarak bulunmuştur.

Anahtar Kelimeler:

akut pankreatit, akut tekrarlayan pankreatit, kronik pankreatit, etyoloji

PANCREATITIS IN CHILDREN: A SINGLE CENTER EXPERIENCE

Objective: The aim of this study was to evaluate the clinical, laboratory and etiological differences between children having acute pancreatitis, acute recurrent pancreatitis and chronic pancreatitis. Method: Medical records of children who were diagnosed with pancreatitis between January 2014 and December 2017 were evaluated retrospectively. The study was approved by the Ethics Committee of Afyonkarahisar University of Health Sciences. Our cases were classified as acute pancreatitis, acute recurrent pancreatitis and chronic pancretitis according to INSPPIRE group definitions. Results: Etiology, demographic characteristics, laboratory and radiological findings were compared between acute pancreatitis (group 1) and acute recurrent and chronic pancreatitis (group 2) groups. 43 patients (78.2%) were enrolled in acute pancreatitis group (group 1). In group 2; 8 cases had acute recurrent pancreatitis and 4 cases had chronic pancreatitis [a total of 12 cases (21.8%)]. the etiologies of our cases were examined; Group 1 had idiopathic (88.5%), stone (2.3%), trauma (2.3%), infections (4.6%) and choledochal cyst (2.3%), respectively. In group 2, they were found to be idiopathic (50%), congenital anomalies of the pancreatic duct (8.3%), allergy (8.3%), autoimmunity (8.3%) and genetic causes (25%). There was no statistical difference between the groups in terms of laboratory values. In our study, the cause of pancreatitis could not be generally identified in all groups. Conclusions: In cases having acute pancreatitis, infections were the second most common etiology; and common causes of acute recurrent and chronic pancreatitis have been found as genetic causes.

Keywords:

acute pancreatitis, acute recurrent pancreatitis, chronic pancreatitis, etiology,

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2. Morinville, V. D., Lowe, M. E., Ahuja, M., Barth, B., Bellin, M. D., Davis, H., et.al. Design and implementation of INSPPIRE. J Pediatr Gastroenterol Nutr. 2014;59(3):360-364. doi:10.1097/MPG.0000000000000417.
3. Morinville V.D, Husain S.Z, Bai H, Barth B, Alhosh R, Durie P.R, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr. 2012;55(3):261-265. doi:10.1097/MPG.0b013e31824f1516
Petrov MS, Yadav D. Global epidemiology and holistic prevention of pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(3):175-184. doi:10.1038/s41575-018-0087-5
Poddar U, Yachha SK, Borkar V, Srivastava A, Kumar S. A Report of 320 Cases of Childhood Pancreatitis. Pancreas. 2017;46(1):110-115. doi:10.1097/MPA.0000000000000733
Kandula L, Lowe ME. Etiology and Outcome of Acute Pancreatitis in Infants and Toddlers. J Pediatr. 2008;152(1):106-110.e1. doi:10.1016/J.JPEDS.2007.05
Pant C, Deshpande A, Olyaee M, Anderson M P, Bitar A, Steele M.I, et al. Epidemiology of Acute Pancreatitis in Hospitalized Children in the United States from 2000–2009. Rakonczay Z, ed. PLoS One. 2014;9(5):e95552. doi:10.1371/journal.pone.0095552
Ünlüsoy Aksu A, Sarı S, Eğritaş Gürkan Ö, Dalgıç B. Türk çocuklarda pankreatit: tek merkez deneyimi. Cukurova Med J. 2019;44(3):1-1. doi:10.17826/cumj.511605
Alabdulkareem A, Almahmoud T, Al-Tahan H, Javad S, Al Hatlani M. Etiology and clinical characteristics of pediatric acute pancreatitis in Saudi Arabia: a 20-year experience from a single tertiary center. Int J Pediatr Adolesc Med. 2018;5(1):13-17. doi:10.1016/j.ijpam.2018.01.001
Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr. 2011;52(3):262-270. doi:10.1097/MPG.0b013e3182061d75
Taylor C.J, Chen K, Horvath K, Hughes D, Lowe M.E, Mehta D, et al. ESPGHAN and NASPGHAN Report on the Assessment of Exocrine Pancreatic Function and Pancreatitis in Children. 2015. doi:10.1097/MPG.000000000000083
. Abu-El-Haija M, Kumar S, Quiros J.A, Balakrishnan K, Barth B, Bitton S, et al. Management of Acute Pancreatitis in the Pediatric Population: A Clinical Report From the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2018; 66(1):159-176. doi:10.1097/MPG.0000000000001715