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.
