Pediatric Pancreatitis Clinical Presentation

Updated: Aug 15, 2016
  • Author: Andre Hebra, MD; Chief Editor: Carmen Cuffari, MD  more...
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Presentation

History and Physical Examination

Classically, pancreatitis in adults presents with midepigastric pain radiating to the back. In children, the presenting signs and symptoms can be quite varied. Most commonly, a child with acute pancreatitis presents with abdominal pain (87%), vomiting (64%), abdominal tenderness (77%), and abdominal distention (18%). Other, less common clinical signs include fever, tachycardia, hypotension, jaundice, abdominal guarding, rebound tenderness, and decreased bowel sounds. Eating may exacerbate the abdominal pain.

Acutely ill children may lie on their side with the hips and knees flexed. The pain typically increases in intensity for 24-48 hours. The clinical course for acute pancreatitis is variable. Often, children may require hospitalization for analgesia, bowel rest, and rehydration with fluid and electrolyte therapy.

Acute hemorrhagic pancreatitis

Acute hemorrhagic pancreatitis rarely occurs in children. This is a life-threatening condition with a mortality rate approaching 50% because of shock, systemic inflammatory response syndrome with multiple organ dysfunction, acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation (DIC), massive gastrointestinal bleeding, and systemic or peritoneal infection.

Physical examination findings associated with hemorrhagic pancreatitis may include a bluish discoloration of the flanks (ie, Grey Turner sign) or periumbilical region (ie, Cullen sign) because of blood accumulation in the fascial planes of the abdomen. Additional signs include pleural effusions, hematemesis, melena, and coma.

Chronic pancreatitis

Chronic pancreatitis in children is associated with trauma, systemic disease, and pancreaticobiliary malformations, most commonly pancreatic divisum. In the United States, the most common cause of chronic relapsing pancreatitis in children is hereditary pancreatitis. Patients with this disease typically present with chronic abdominal pain that can be difficult to treat. These patients have recurrent episodes of upper abdominal pain associated with varying degrees of pancreatic dysfunction and have increased risk of developing pancreatic insufficiency, adenocarcinoma, and pancreatic pseudocysts.

Pancreatic pseudocysts

Children with pancreatic pseudocysts may present with localized abdominal pain and a palpable tender epigastric mass or abdominal fullness. Additional symptoms include jaundice, chest pain, nausea, vomiting, anorexia, weight loss, fever, ascites, and rarely, GI hemorrhage.