జర్నల్ ఆఫ్ క్లినికల్ గ్యాస్ట్రోఎంటరాలజీ అండ్ హెపటాలజీ అందరికి ప్రవేశం

నైరూప్య

Acute pancreatitis

Abdulhakim AlMuhandes

Background : Acute  pancreatitis(AP)  is  an emerging  problem in pediatrics  with an incidence  that  is  rising  in the  last two  decades worldwide. The natural course of this condition unknown in Saudi Arabia. Aim of study: To  define  the  most  common  causes  of  AP in  Saudi Arabia • Review  the  clinical presentation ,laboratory  data,  imaging  and  outcome In  children  with  AP  seen   at  tertiary  care center  in  Saudi Arabia .Patients and methods: Retrospective  chart  review  study   include  patients  with  AP  who  are  less  than  18  years of age  . • Duration of study 2007–2017. •demographic, clinical, laboratory, imaging and outcome data were collected and analyzed. • Results: Total of 147 patients (78 male 53%)   was included. Main  age  at  presentation   8.6  years • With  the  younger  patient  18  months and  older  one  18  years. • Consanguinity  is  seen  in  119  (80.9%) • family history  of  pancreatitis  5  cases 3.4% • Recurrence seen  in  58  patients (39.4%) • Mean hospital  stay 6.6  days • complications 25 (17 %) with the most common peri pancreatic fluids (N8:5.44%) and pancreatic pseudo cyst(N 7:4.77%) No PICU admission • No mortality. Methylmalonic acidemia the most common cause 26 (17.68 %) and the third common cause propionic acidemia 16 (10.88%) as study done in tertiary Referrence center. The second most common cause of AP drugs induce 18 (12.24 %) gallbladder and common bile duct stones 15 ( 10.2%) trauma 12 (8.16% ) idiopathic 9 (6.12 %) cystic fibrosis 6 (4 %) end stage renal disease 6 (4%). Clinically vomiting 139 (94 .5 %) abdominal pain 135 (91.8 %) with back pain in (N 23:15.6 %) were most commonly encountered. Lipase tested in 146/ 147 were high in all cases with median 655 U/ mean    1056 U/L standard deviation 1002 Amylase less tested in 96 / 147 patients were high  in all of them . Median     259 U/L Mean 496 U/L standard deviation 679 U/L .Abdominal US (n=121:79.59%) non-yielding in 55%. Swelling of the pancreas were the most detected (N=30; 25.6%) followed by pseudo cyst then biliary stones. CT scan (N=70:47.95 %) with positive finding in 60.31% with most common finding pancreatic swelling followed by pancreatic pseudocyst. MRI (N 50:34%) positive findings in 82.5 % pancreatic duct dilatation were the most detected. ERCP (N15:10.2%) 9 patients CBD stone removal 6 patients stent insertion. Conclusion : Although relatively uncommon in Saudi Arabia nearly 14 to 15 cases diagnosed in our hospital per year .Methylmalonic   acidemia  is  the  most  common  cause  of  AP  in  our  patients  which  may reflect  the  nature  of  referral  to  KFSH&RC. • Drugs induced AP  is   common  in  hematology/oncology  and IBD patients . The mean length  of  stay  is  6.6  days • Complications  seen  in  17% • Intervention is seen in  16  %. • No ICU admission • No mortality.