Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Computed Tomography Assessment of Severity of Acute Pancreatitis in Bangladeshi Children

  • Kaniz Fathema (Department of Pediatric Gastroenterology and Nutrition, Sir Salimullah Medical College Mitford Hospital) ;
  • Bazlul Karim (Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University) ;
  • Salahuddin Al-Azad (Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University) ;
  • Md. Rukunuzzaman (Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University) ;
  • Mizu Ahmed (Department of Dermatology, Shahid Syed Nazrul Islam Medical College Hospital) ;
  • Tasfia Jannat Rifah (Department of Pediatric Gastroenterology and Nutrition, Bangabandhu Sheikh Mujib Medical University) ;
  • Dipanwita Saha (Department of Pediatric Gastroenterology and Nutrition, Comilla Medical College) ;
  • Md. Benzamin (Department of Pediatric Gastroenterology and Nutrition, Sylhet MAG Osmani Medical College Hospital)
  • Received : 2023.05.20
  • Accepted : 2023.10.30
  • Published : 2024.05.15
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Abstract

Purpose: Acute pancreatitis (AP) is common among children in Bangladesh. Its management depends mainly on risk stratification. This study aimed to assess the severity of pediatric AP using computed tomography (CT). Methods: This cross-sectional, descriptive study was conducted in pediatric patients with AP at the Department of Pediatric Gastroenterology and Nutrition, BSMMU, Dhaka, Bangladesh. Results: Altogether, 25 patients with AP were included, of whom 18 (mean age, 10.27±4.0 years) were diagnosed with mild AP, and 7 (mean age, 10.54±4.0 years) with severe AP. Abdominal pain was present in all the patients, and vomiting was present in 88% of the patients. Etiology was not determined. No significant differences in serum lipase, serum amylase, BUN, and CRP levels were observed between the mild and severe AP groups. Total and platelet counts as well as hemoglobin, hematocrit, serum creatinine, random blood sugar, and serum alanine aminotransferase levels (p>0.05) were significantly higher in the mild AP group than in the severe AP group (p=0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of CT severity index (CTSI) were 71.4%, 72.2%, 50%, and 86.7%, respectively. In addition, significant differences in pancreatic appearance and necrosis were observed between the two groups on CT. Conclusion: CT can be used to assess the severity of AP. In the present study, the CTSI effectively assessed the severity of AP in pediatric patients.

Keywords

Acknowledgement

This study is supported by Bangabandhu Sheikh Mujib Medical University research grant.

References

  1. Bai HX, Lowe ME, Husain SZ. What have we learned about acute pancreatitis in children? J Pediatr Gastroenterol Nutr 2011;52:262-70. https://doi.org/10.1097/MPG.0b013e3182061d75
  2. Lankisch PG, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB. Acute pancreatitis: does gender matter? Dig Dis Sci 2001;46:2470-4. https://doi.org/10.1023/A:1012332121574
  3. Lerch MM, Gorelick FS. Models of acute and chronic pancreatitis. Gastroenterology 2013;144:1180-93.  https://doi.org/10.1053/j.gastro.2012.12.043
  4. Yoon SB, Lee IS, Choi MH, Lee K, Ham H, Oh HJ, et al. Impact of fatty liver on acute pancreatitis severity. Gastroenterol Res Pract 2017;2017:4532320.
  5. Abu-El-Haija M, Kumar S, Szabo F, Werlin S, Conwell D, Banks P, et al.; NASPGHAN Pancreas Committee. Classification of acute pancreatitis in the pediatric population: clinical report From the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr 2017;64:984-90. https://doi.org/10.1097/MPG.0000000000001583
  6. Shelton C, LaRusch J, Whitcomb DC. Pancreatitis overview. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Bean LJH, et al., eds. GeneReviews®. University of Washington, Seattle, 1993.
  7. Chang JWY, Chung CH. Diagnosing acute pancreatitis: amylase or lipase? Hong Kong J Emerg Med 2011;18:20-5. https://doi.org/10.1177/102490791101800104
  8. Szabo FK, Fei L, Cruz LA, Abu-El-Haija M. Early enteral nutrition and aggressive fluid resuscitation are associated with improved clinical outcomes in acute pancreatitis. J Pediatr 2015;167:397-402.e1. https://doi.org/10.1016/j.jpeds.2015.05.030
  9. Lautz TB, Chin AC, Radhakrishnan J. Acute pancreatitis in children: spectrum of disease and predictors of severity. J Pediatr Surg 2011;46:1144-9. https://doi.org/10.1016/j.jpedsurg.2011.03.044
  10. Werner J, Hartwig W, Uhl W, Muller C, Buchler MW. Useful markers for predicting severity and monitoring progression of acute pancreatitis. Pancreatology 2003;3:115-27. https://doi.org/10.1159/000070079
  11. Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology 1985;156:767-72. https://doi.org/10.1148/radiology.156.3.4023241
  12. Balthazar EJ. Complications of acute pancreatitis: clinical and CT evaluation. Radiol Clin North Am 2002;40:1211-27. https://doi.org/10.1016/S0033-8389(02)00043-X
  13. Morinville VD, Husain SZ, Bai H, Barth B, Alhosh R, Durie PR, et al. Definitions of pediatric pancreatitis and survey of present clinical practices. J Pediatr Gastroenterol Nutr 2012;55:261-5. Erratum in: J Pediatr Gastroenterol Nutr 2013;56:459.
  14. Nydegger A, Heine RG, Ranuh R, Gegati-Levy R, Crameri J, Oliver MR. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children's Hospital, Melbourne. J Gastroenterol Hepatol 2007;22:1313-6. https://doi.org/10.1111/j.1440-1746.2007.04936.x
  15. Musabbir N, Karim AB, Sultana K, Anwar SA. Liver involvement in Langerhans' cell histiocytosis a case report. North Int Med Coll J 2016;7:158-60. https://doi.org/10.3329/nimcj.v7i2.29663
  16. Vitale DS, Hornung L, Lin TK, Nathan JD, Prasad S, Thompson T, et al. Blood urea nitrogen elevation is a marker for pediatric severe acute pancreatitis. Pancreas 2019;48:363-6. https://doi.org/10.1097/MPA.0000000000001265
  17. Galai T, Cohen S, Yerushalmy-Feler A, Weintraub Y, Moran-Lev H, Amir AZ. Young age predicts acute pancreatitis severity in children. J Pediatr Gastroenterol Nutr 2019;68:720-6. https://doi.org/10.1097/MPG.0000000000002294
  18. Pezzilli R, Morselli-Labate AM, Castellano E, Barbera C, Corrao S, Di Prima L, et al. Acute pancreatitis in children. An Italian multicentre study. Dig Liver Dis 2002;34:343-8. https://doi.org/10.1016/S1590-8658(02)80128-1
  19. Farrell PR, Hornung L, Farmer P, DesPain AW, Kim E, Pearman R, et al. Who's at risk? A prognostic model for severity prediction in pediatric acute pancreatitis. J Pediatr Gastroenterol Nutr 2020;71:536-42.  https://doi.org/10.1097/MPG.0000000000002807
  20. Peng T, Peng X, Huang M, Cui J, Zhang Y, Wu H, et al. Serum calcium as an indicator of persistent organ failure in acute pancreatitis. Am J Emerg Med 2017;35:978-82. Erratum in: Am J Emerg Med 2017;35:1785. 
  21. Izquierdo YE, Fonseca EV, Moreno LA, Montoya RD, Guerrero R. Multivariate model for the prediction of severity of acute pancreatitis in children. J Pediatr Gastroenterol Nutr 2018;66:949-52. https://doi.org/10.1097/MPG.0000000000001983
  22. Lautz TB, Turkel G, Radhakrishnan J, Wyers M, Chin AC. Utility of the computed tomography severity index (Balthazar score) in children with acute pancreatitis. J Pediatr Surg 2012;47:1185-91. https://doi.org/10.1016/j.jpedsurg.2012.03.023
  23. Fabre A, Petit P, Gaudart J, Mas E, Vial J, Olives JP, et al. Severity scores in children with acute pancreatitis. J Pediatr Gastroenterol Nutr 2012;55:266-7. https://doi.org/10.1097/MPG.0b013e318254c1c7
  24. Hashimoto N, Yotani N, Michihata N, Tang J, Sakai H, Ishiguro A. Efficacy of pediatric acute pancreatitis scores at a Japanese tertiary center. Pediatr Int 2016;58:224-8. https://doi.org/10.1111/ped.12774