Pancreatitis in childhood

Ninety children treated for acute, relapsing, or chronic pancreatitis at the Red Cross War Memorial Children's Hospital, Cape Town, between 1958 and 1982 are reviewed. The commonest cause was Ascaris worms in the bile duct and the next commonest identifiable cause was trauma. Diagnosis was clinical, confirmed by raised amylase levels and radiological or operative findings. Ultrasound was particularly helpful. Treatment was initially non-operative but operations were done in 33 patients because of complications or diagnostic doubt. Pseudocyst formation was the commonest complication (20 patients) and 40% of pseudocysts resolved without treatment within 3 weeks. The remainder were drained, mostly by cyst-gastrostomy, but 3 were successfully drained externally. The long-term outcome was satisfactory in 90% of patients; 1 child developed insulin-dependent diabetes and only 2 died (3.3% mortality). We consider that pancreatitis is probably underdiagnosed in children; many cases are relatively mild. Our patients had a low mortality compared with other series containing a higher proportion of immunocompromised patients on corticosteroid and cytotoxic drug therapy.