Abdominal pain in the Pediatric ED is an exceedingly common complaint. Typically, it is due to relatively common etiologies (ex. Appendicitis, pneumonia, UTI, Torsions, constipation) and we are all adept at looking for these potential issues. Often we consider other entities, but so rarely see it, that we are surprised when a lab result points us in a “new” direction. Such an event happened this past week to me when a young girl, who looked really well, presented with epigastric abdominal pain… and blood that separated out like oil and water (see picture above… thanks to Dr. Katie Mahoney for snagging this blood sample). The patient ended up with elevated lipase and triglycerides that were through the roof.

So, while pancreatitis will be seen much more commonly on the adult side (where our patients love to drink too many beers and have biliary disease), it is likely more common on the pediatric side than we appreciate.

Etiologies to consider for pancreatitis in pediatric patients

(the percentages come from cited study)

Acute:
(1) Trauma (~22%)
(2) Viral or Bacterial Infections (10%)
(3) Toxins / Medications (12%)
(4) Biliary obstruction (ex, stones)
(5) Systemic diseases (ex, diabetes, Crohn’s disease) (14%)

Chronic:
(1) Congenital structural anomalies (15%)
(2) Autoimmune D/O (also part of the 14% seen with systemic diseases)
(3) Cystic Fibrois (also part of the 14% seen with systemic diseases)
(4) Metabolic D/O [High Lipids and/or Hypercalcemia] (2%)
(1) Idiopathic (~23% of all cases)

• Over the past decades, there have been more reported cases of pancreatitis in children and more defined etiologies (less being called idiopathic).
• Adult Scoring systems (Ranson, modified Glasgow) have not been shown to acutely predict the severity of pediatric pancreatitis.
• Initial imaging modality of choice in the non-trauma patient would be ultrasound. The trauma patient may benefit more from Abd CT scan.

Benifla M, Weizman Z. Acute Pancreatitis in Childhood: analysis of literature data. J Clin Gastroenterol. 2003: 37(2): 169-172