Çocuklarda akut pankreatit: Ne hafife alınmalı, ne de gözden kaçırılmalı

Year 2024, Articles Online First, 1 - 7

Burcu Cura Yayla , Ceyda Tuna Kırsaçlıoğlu , Tülin Şaylı

https://doi.org/10.12956/tchd.1508708

Abstract

Amaç: Çocuklarda akut pankreatitin (AP) farklı prezentasyonlarına rağmen, farkındalığın artması nedeniyle son yıllarda tanısı artmaktadır. Bu çalışmada akut pankreatitli çocuklarda etiyoloji, başvuru semptomları, tedavi yanıtı ve komplikasyonlar arasındaki ilişkiyi belirlemeyi amaçladık.

Gereç ve Yöntemler: Üçüncü basamak çocuk hastanesinde AP tanısı alan 30 çocuk klinik ve laboratuvar bulguları, tedavi yaklaşımları, komplikasyonlar açısından retrospektif olarak değerlendirildi.

Bulgular: Hastaların yaş ortalaması 12.4±4.3 yıldı ve %60’ı erkekti. İlaçlar (%30), safra yolu hastalıkları (%26.7), enfeksiyonlar (%16.7), hiperlipidemi (%10) AP’nin ana nedenleriydi, hastaların %10’unda etiyolojik faktör saptanmadı. Karın ağrısı (%83.3), bulantı (%70), iştahsızlık (%63.3), kusma (%56.7) ve ateş (%20) en sık görülen semptomlardı. Ultrasonografi, abdominal tomografi ve manyetik rezonans kolanjiyopankreatografi hastaların sırasıyla %63.3, %85, %70’inde pankreatitle ilişkili değişiklikler olduğunu gösterdi. Oral beslenme ortanca 4 günde (1-30), polimerik diyet (%30) ve orta zincirli trigliseritten zengin enteral diyet (%70) ile başlatıldı. Ortanca hastanede yatış süresi (LOH) 16.5 gündü (4-66). Polimerik diyetle beslenen hastaların hastanede yatış süresi daha kısaydı (p<0.036). Oral beslenmeye geç başlanması daha uzun LOH ile ilişkili olduğu saptandı (p<0.001).

Sonuç: Sonuç olarak, bu çalışma akut karın ağrısı olan, özellikle asparajinaz ve valproik asit gibi ilaçlar kullanan veya safra taşı/safra çamuru olduğu bilinen çocukların pankreas enzimleri ve ultrasonografi ile akut pankreatit açısından incelenmesi gerektiğinin altını çizmektedir. Çalışma ayrıca, akut pankreatitte erken beslenmenin daha kısa hastanede yatış süresi ile ilişkili olduğunu vurgulamaktadır.

Keywords

Akut pankreatit, çocuklar, etiyoloji, tedavi

Acute Pancreatitis in Children: Neither to be Underestimated Nor to be Overlooked

Abstract

Objective: Despite varying presentations of acute pancreatitis (AP) in children, the diagnosis has been increasing in recent years due to increased awareness. We aimed to identify the relationship among etiology, presentation symptoms, treatment response and complications of the children with acute pancreatitis.

Material and Methods: Thirty children diagnosed with AP were evaluated for clinical and laboratory findings, treatment approaches, complications in the tertiary children hospital retrospectively.

Results: The mean age of the patients was 12.4 ± 4.3 years and 60% were male. The drugs (30%), biliary tract diseases (26.7%), infections (16.7%), hyperlipidemia (10%) were the main causes of AP, in 10% of patients no etiological factor was detected. Abdominal pain (83.3%), nausea (70%), loss of appetite (63.3%), vomiting (56.7%), and fever (20%) were the most common symptoms. Ultrasonography, abdominal tomography and magnetic resonance cholangiopancreatography revealed pancreatitis related changes 63.3%, 85%, 70% of patients, respectively. Oral feeding was started on median 4 days (1-30), with polymeric diet (30%), and medium chain triglyceride rich enteral diet (70%). The median length of hospitalization (LOH) was 16.5 days (4-66). The patients fed with polymeric diet had a shorter hospitalization duration (p<0.036). The delayed initiation of oral feeding caused longer LOH (p<0.001).

Conclusion: Consequently, this study underlines the children with acute abdominal pain, especially who use drugs like asparaginase and valproic acid, or that are known to have gallstone/biliary sludge, need to be examined for acute pancreatitis through pancreatic enzymes and ultrasonography. Moreover, the study also highlights that early feeding in acute pancreatitis is related with shorter hospitalization duration.

Keywords

Acute pancreatitis, children, etiology, treatment

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