Pancreatitis
Key points
Aetiology in children
Idiopathic
Genetic
Trauma
Congenital abnormalities e.g. pancreas divisum, choledochal cyst
Gallstones - haemolytic anaemias
Cystic fibrosis
Infective: In order of most common organisims - Hepatitis B, Cocksackie B, Echovirus, Mumps (paramyxovirus)
Drugs e.g. L Asparaginase in leukaemia
Embryology of the pancreas
Embryological Development
The pancreas arises from the endoderm of the foregut around the 5th week of gestation
It develops from two buds:
· Dorsal bud: Forms first; gives rise to body, tail, and part of the head
· Ventral bud: Arises near the bile duct; forms the uncinate process and part of the head
The buds fuse around the 7th week to form the definitive pancreas
Pancreatobiliary maljunction can happen when there is problems with fusion
Congenital Anomalies
Annular pancreas: Pancreatic tissue encircles the duodenum
Pancreas divisum: Failure of ductal fusion; may predispose to pancreatitis
Ectopic pancreas, agenesis, or hypoplasia: Rare but may complicate diagnosis and management
Anatomy
Head: Nestled in the duodenal “C-loop”
Uncinate process: Posterior to the superior mesenteric vessels (SMA, SMV)
Neck: Lies anterior to the portal vein confluence
Body: Crosses midline at L2
Tail: Lies within the splenorenal ligament near the spleen
Vascular Supply
Arterial:
Head: Superior pancreaticoduodenal (gastroduodenal artery) and inferior pancreaticoduodenal (SMA)
Body and Tail: Branches from the splenic artery
Venous:
Drains into the portal vein
Innervation
Sympathetic: Coeliac plexus — involved in pain transmission
Parasympathetic: Vagus nerve — regulates exocrine secretion
Genetics
PRSS1 (cationic trypsinogen) gene - most common - autosomal dominant
CTRC (chymotrypsin) and CASR (calcium-sensing receptor)
SPINK1 - high risk of chronic pancreatitis
IGG4
Schwachman-Diamond syndrome
Autosomal recessive
1. Pancytopenia
2. Pancreatic insufficiency
3. Growth restriction
Investigations
Amylase/Lipase to confirm diagnosis
Liver function tests, calcium etc for Glasgow score
Faecal elastase for chronic pancreatitis (will be low)
USS for gallstones
CT from 7 days onwards if complications suspected such as necrosis, splenic vessel pseudoaneurysm
Peripancreatic collections can form pseudocyst after developing thick wall (usually takes 3-4 weeks)
CT/MRCP to diagnose and to plan drainage
Secretin given before MRCP can make it more sensitive in detecting pancreas divisum - by increasing sphincter of Oddi pressure
Management
Do not use prophylactic antibiotics - selects out resistant organisms in later collections
Always attempt enteral feeds - NJ tube may be needed
Endoscopic cystgastrostomy e.g. AXIOS hot stent for drainage of pseudocyst that is not resolving
Remove stent endoscopically in 4-6 weeks, can perform cholecystectomy at the same time if GS present
Necrosectomy for extremely rare cases of infected necrosis not responding to supportive measures
10-20% mortality
Cases of chronic pancreatitis with intractable pain and a dilated pancreatic duct may be suitable for a pancreatojejunostomy
Page edited by Prof. Ashok Daya Ram MBBS, FRCS, FRCPS, FEBPS, FRCS (Paed Surgery), Consultant Paediatric and Neonatal Surgeon, Norfolk and Norwich University Hospital, Norwich, UK. October 2025
References
Suzuki M, Sai JK, Shimizu T. Acute pancreatitis in children and adolescents. World J Gastrointest Pathophysiol. 2014 Nov 15;5(4):416-26. doi: 10.4291/wjgp.v5.i4.416. PMID: 25400985; PMCID: PMC4231506.
Panchoo AV, VanNess GH, Rivera-Rivera E, Laborda TJ. Hereditary pancreatitis: An updated review in pediatrics. World J Clin Pediatr. 2022 Jan 9;11(1):27-37. doi: 10.5409/wjcp.v11.i1.27. PMID: 35096544; PMCID: PMC8771313.
Farooqui SM, Ward R, Aziz M. Shwachman-Diamond Syndrome. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507866/
Boam T et al. Surgical drainage procedures for paediatric chronic pancreatitis: a scoping review. Pediatr Surg Int. 2022 Dec;38(12):1949-1964. doi: 10.1007/s00383-022-05242-8. Epub 2022 Sep 26. PMID: 36163306.