Singapore Med J 2003 Vol 44(9) : 453-456
O r i g i n a l A r t i c l e
Childhood Acute Pancreatitis in a
S-K Goh, C H Chui, A S Jacobsen
KK Women s and
Children s Hospital
S-K Goh, MA,
C H Chui,
A S Jacobsen,
C H Chui
Tel: (65) 6293 4044
Fax: (65) 6291 0161
Objective: To analyse the cases of acute pancreatitis
presented to a children’s hospital in Singapore.
Methods: Clinical charts of all children, aged under
18 years, who presented to our hospital for the
first time with pancreatitis (ICD search criteria =
577.x) between the period of 1998 and mid-2002
were reviewed. Parameters analysed included
presenting features, aetiology of the acute
pancreatitis, length of hospital stay, complications,
treatment and outcome.
Results: There were 12 cases in the review period,
and the attributable causes in these cases were,
in descending order, trauma, drug-induced,
anatomical anomalies, poisoning and idiopathic.
Of interest were two patients whose pancreatitis
were results of child abuse. The most common
symptoms were abdominal pain (n=11) and
vomiting (n=7), though only five patients localised
the pain to the epigastrium. Abdominal tenderness
could be elicited in all the patients. Eleven had
evidence of acute pancreatitis from computerised
tomography (CT) whilst the twelfth was diagnosed
with ultrasonography. The peak amylase levels
amongst these patients were not high, with a
median of 512.5 U/L. In the acute stage, only one
patient required operative intervention whilst
the remainder were managed conservatively.
The mean length of hospital stay was 12.41 ± 4.54
days. The complications encountered included
pseudocyst formation, ascites, hypocalcaemia,
pleural effusion and coagulopathy.
Conclusions: The diagnosis of acute pancreatitis
in children can be difficult. This is often due to
ambiguous symptoms, signs and laboratory results.
CT and ultrasound are essential investigations in
the diagnosis and subsequent follow-up.
Keywords: acute pancreatitis, children, child
Singapore Med J 2003 Vol 44(9):453-456
The incidence of acute pancreatitis in children is low
when compared to the adult population(1). Alcohol and
gallstones account for 80% of acute pancreatitis in
adults, and available English literature suggests
that the aetiological pattern of childhood acute
pancreatitis is different. We reviewed all the children
who presented with acute pancreatitis to our hospital
for the first time between 1998 to mid-2002, and report
the aetiology, presenting symptoms and signs, clinical
course and outcome.
PATIENTS AND METHODS
The clinical charts of all paediatric patients of
KK Women’s and Children’s Hospital assigned the
ICD code of 577.x between January 1998 to June
2002 were reviewed. The inclusion criteria were (1)
hyperamylasemia associated with severe abdominal
pain or vomiting, (2) radiological evidence of pancreatic
inflammation, or (3) histological or macroscopic evidence
of acute pancreatitis at laparotomy. Only patients who
were newly diagnosed to have acute pancreatitis were
considered for the study.
Twelve patients were identified with acute pancreatitis.
Their age ranged from 3.17 to 15.75 years (Mean
8.96, SD 3.50). The sex ratio was five males to seven
females. The racial composition of the patients was
similar to the local racial composition.
Trauma (n=5) was the leading attributable cause in
this group of patients, accounting for 41.2% (Fig. 1).
The mechanisms of trauma were varied. One patient
was hit by a car on her flank and another was hit
by a 25-inch television which fell through a height of
two feet at home; one girl was stepped upon on the
abdomen by her twin sister whilst playing at home.
Two patients developed acute pancreatitis following
child abuse whereby a seven-year-old boy was
stepped on the abdomen by his step-father and a