Imaging of Pancreatitis in Children

Authors

  • Chomanad Chittchang Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand and Section of Radiology, Samitivej Srinakarin Hospital, Suan Luang, Bangkok 10250, Thailand.
  • Bernard F. Laya Institute of Radiology, St. Luke’s Medical Center Quezon City and Global City, Department of Radiology, St. Luke’s Medical Center College of Medicine – William H. Quasha Memorial, Quezon City 1112, Philippines.
  • Supika Kritsaneepaiboon Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand.

DOI:

https://doi.org/10.31584/jhsmr.2021812

Keywords:

children, computed tomography, magnetic resonance cholangiopancreatography, pancreatitis, ultrasound

Abstract

Pancreatitis in children has become more recognized over the past decade. Recent studies published by the INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) Group categorizes pediatric pancreatitis according to various etiologies and clinical course of disease in acute pancreatitis (AP), acute recurrent pancreatitis (ARP) and chronic pancreatitis. Imaging modalities help fulfill the diagnosis of AP in cases of atypical clinical context, while imaging also completes the major diagnostic criteria in CP. Ultrasound is the modality of choice to evaluate children with AP. Computed tomography should be reserved to assess the severity of complicated AP, or in the acute traumatic setting due to radiation concerns in children. Magnetic resonance cholangiopancreatography is used for the evaluation of underlying pancreaticobiliary structural abnormalities and for diagnosing CP. The etiologies of pediatric pancreatitis are diverse and unique including biliary stones, pancreaticobiliary structural abnormalities, genetic mutationrelated, drugs, trauma, systemic diseases and autoimmune-related cause. This article provides a pictorial review of the imaging modalities and findings related to the clinical course and etiologies of pediatric pancreatitis (AP, ARP and CP).

References

Nydegger A, Heine RG, Ranuh R, Gegati-Levy R, Crameri J, Oliver MR. Changing incidence of acute pancreatitis: 10-year experience at the Royal Children’s Hospital, Melbourne. J Gastroenterol Hepatol 2007;22:1313–6.

Morinville VD, Barmada MM, Lowe ME. Increasing incidence of acute pancreatitis at an American pediatric tertiary care center: is greater awareness among physicians responsible?. Pancreas 2010;39:5–8.

Park A, Latif SU, Shah AU, Tian J, Werlin S, Hsiao A, et al. Changing referral trends of acute pancreatitis in children: a 12-year single-center analysis. J Pediatr Gastroenterol Nutr 2009;49:316–22.

Cheng YJ, Yang HY, Tsai CF, Lin JS, Lee HC, Yeung CY, et al. Epidemiology of pediatric acute pancreatitis in Taiwan: a nationwide population based study. J Pediatr Gastroenterol Nutr 2019;68:e7-12.

Corfield AP, Cooper MJ, Williamson RC. Acute pancreatitis: a lethal disease of increasing incidence. Gut 1985;26:724-9.

Morinville VD, Husain SZ, Bai H, Durie PR, Freedman SD, Himes R, et al. Definitions of pediatric pancreatitis and survey of current clinical practices. J Pediatr Gastroenterol Nutr 2012;55:261–5.

Uc A, Perito ER, Pohl JF, Shah U, Abu-El-Haija M, Barth B, et al. International study group of pediatric pancreatitis: in search for a cure. Cohort study: design and rationale for INSPPIRE 2 from the consortium for the study of chronic pancreatitis, diabetes, and pancreatic cancer. Pancreas 2018;47:1222-8.

Sanchez-Ramirez CA, Larrosa-Haro A, Flores-Martinez S, Sanchez-Corona J, Villa-Gomez A, Macias-Rosales R. Acute and recurrent pancreatitis in children: etiological factors. Acta Paediatr 2007;96:534-7.

Werlin SL, Kugathasan S, Frautschy BC. Pancreatitis in children. J Pediatr Gastroenterol Nutr 2003;37:591-5.

Spanier B, Bruno MJ, Dijkgraaf MG. Incidence and mortality of acute and chronic pancreatitis in the Netherlands: a nationwide record-linked cohort study for the years 1995– 2005. World J Gastroenterol 2013;19:3018-26.

Kumar S MD, Ooi CY, Werlin S, Abu-El-Haija M, Barth B, Bellin MD, et al. Pediatric acute recurrent and chronic pancreatitis. JAMA Pediatr 2016;170:562–9.

Schwarzenberg SJ, Bellin M, Husain SZ, Ahuja M, Barth B, Davis H, et al. Pediatric chronic pancreatitis is associated with genetic risk factors and substantial disease burden. J Pediatr 2015;166:890-6.

O'Connor OJ, Buckley JM, Maher MM. Imaging of the complications of acute pancreatitis. Am J Roentgenol 2011: 197:W375-81.

Pickhardt PJ. The colon cutoff sign. Radiology 2000;215:387-9.

Parker BR. The pancreas. In: Kuhn JP, Slovis TL, Haller JO, editors. Caffey’s Pediatric Diagnostic Imaging. 10th ed. Pennsylvania: Mosby; 2004;p.1527-36.

Seigel MJ, Martin KW, Worthington JL. Normal and abnormal pancreas in children: US studies. Radiology 1987;165:15-8.

Jeffry RB Jr. Sonography in acute pancreatitis. Radiol Clin North Am 1989;27:5-17.

Chao HC, Lin SJ, Kong MS, Kuo CC. Sonographic evaluation of the pancreatic duct in normal children and children with pancreatitis. J Ultrasound Med 2000;19:757-63.

Seigel MJ, Chung EM. Adrenal glands, pancreas, and other retroperitoneal structures. In: Seigel MJ, editor. Pediatric Sonography. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2011;p.461-504.

Chang YJ, Chao HC, Kong MS, Hsia SH, Lai MW, Yan DC. Acute pancreatitis in children. Acta Paediatr 2011;100:740-4.

Chen CF, Kong MS, Lai MW, Wang CJ. Acute pancreatitis in children: 10-year experience in a medical center. Acta Paediatr Taiwan 2006;47:192-6.

Orkin SH, Trout AT, Fei L, Lin TK, Nathan JD, Thompson T, et al. Sensitivity of biochemical and imaging findings for the diagnosis of acute pancreatitis in children. J Pediatr 2019;213: 143-8.

Vaughn DD, Jabra AA, Fishman EK. Pancreatic disease in children and young adult: evaluation with CT. Radiographics 1998;18: 1171-7.

Lin TK, Troendle DM, Wallihan DB, Barth B, Fox VL, Fishman DS, et al. Specialized imaging and procedures in pediatric pancreatology: a North American society for pediatric gastroenterology, hepatology, and nutrition clinical report. J Pediatr Gastroenterol Nutr 2017;64:472–4.

Abu-El-Haija M, Kumar S, Quiros JA. The Management of acute Pancreatitis in the pediatric population: a clinical report from the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr 2018;66:159–6.

Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology 1990;174:331-6.

Lautz TB, Turkel G, Radhakrishnan J, Wyers M, Chin AC. Utility of the computed tomography severity index (Balthazar score) in children with acute pancreatitis. J Pediatria Surg 2012;47:1185-91.

Izquierdo YE, Fonseca EV, Moreno L , Montoya RD, Guerrero Lozano R. Utility of CT classifications to predict unfavorable outcomes in children with acute pancreatitis. Pediatr Radiol 2018;48:954-61.

Li W, Luo S, Zhu Y, Shu M, Wen Y, Wang Z, et al. Concordance of the Balthazar Grade and the Revised Atlanta Classification: Proposing a Modified Balthazar Grade to Predict the Severity of Acute Pancreatitis in Pediatric Population. Pancreas 2018;47:1312-6.

Thai TC, Riherd DM, Rust KR. MRI manifestations of pancreatic disease, especially pancreatitis in the pediatric population. Am J Roentgenol 2013;201:W877-92.

Pema D, Kritsaneepaiboon S. Radiation dose from computed tomography scanning in patients at Songklanagarind Hospital: diagnostic reference levels. J Health Sci Med Res 2020;38:135-43.

Barral M, Taouli B, Guiu B, Koh DM, Luciani A, Manfredi R, et al. Diffusion-weighted MR imaging of the pancreas: current status and recommendations. Radiology 2015;274:45– 63.

Park DH, Kim MH, Lee SK, Lee SS, Choi JS, Lee YS, et al. Can MRCP replace the diagnostic role of ERCP for patients with choledochal cysts?. Gastrointest Endosc 2005;62:360–6.

Hwang JY, Yoon HK, Kim KM. Characteristics of pediatric pancreatitis on magnetic resonance cholangiopancreatography. Pediatr Gastroenterol Hepatol Nutr 2015;18:73-84.

Restrepo R, Hagerott HE, Kulkarni S, Yasrebi M, Lee EY. Acute pancreatitis in pediatric patients: demographics, etiology, and diagnostic imaging. Am J Roentgenol 2016;206:632-44.

Chavhan GB, Babyn PS, Manson D, Vidarsson L. Pediatric MR cholangiopancreatography: principles, technique, and clinical applications. Radiographics 2008;28:1951-62.

Frisch A, Walter TC, Hamm B, Denecke T. Efficacy of oral contrast agents for upper gastrointestinal signal suppression in MRCP: A systematic review of the literature. Acta Radiol Open 2017. doi: 10.1177/2058460117727315.

Marugami N, Takewa M, Iwaki Y, Hazeyama Y, Iwato K, Takahama J, et al. MR signal changes on hepatobiliary imaging after oral ingestion of manganese chloride tetrahydrate: preliminary examination. Jpn J Radiol 2013;31: 713–23.

Suzuki M, Sai JK, Shimizu T. Acute pancreatitis in children and adolescents. World J Gastrointest Pathophysiol 2014;5: 416-26.

Gariepy CE, Heyman MB, Lowe ME, Pohl JF, Werlin SL, Wilschanski M, et al. The causal evaluation of acute recurrent and chronic pancreatitis in children: consensus from the INSPPIRE group. J Pediatr Gastroenterol Nutr 2017;64: 95-103.

Sutton R, Cheslyn-Curtis S. Acute gallstone pancreatitis in childhood. Ann R Coll Surg Engl 2001;83:406–8.

Choi BH, Lim YJ, Yoon CH, Kim EA, Park YS, Kim KM. Acute pancreatitis associated with biliary disease in children. J Gastroenterol Hepatol 2003;18:915–21.

Fujishiro J, Masumoto K, Urita Y, Shinkai T, Gotoh C. Pancreatic complications in pediatric choledochal cysts. J Pediatr Surg 2013;48:1897-902.

Okada A, Higaki J, Nakamura T, Fukui Y, Kamata S. Pancreatitis associated with choledochal cyst and other anomalies in childhood. Br J Surg 1995;82:829–32.

Guelrud M, Morera C, Rodriguez M, Prados JG, Ja n D. Normal and anomalous pancreaticobiliary union in children and adolescents. Gastrointestinal endoscopy 1999;50:189-93.

Urushihara N, Hamada Y, Kamisawa T, Fujii H, Koshinaga T, Morotomi Y, et al. Classification of pancreaticobiliary maljunction and clinical features in children. J Hepatobiliary Pancreat Sci 2017;24:449–55.

Todani T, Watanabe Y, Narusue M, Tabuchi K, Okajima K. Congenital bile duct cysts: classification, operative procedures, and review of thirty-seven cases including cancer arising from choledochal cyst. Am J Surg 1977;134:263–9.

Bhavsar MS, Vora HB, Giriyappa VH. Choledochal cysts: a review of literature. Saudi J Gastroenterol. 2012;4:230-6.

Santiago I, Loureiro R, Curvo-Semedo L, Marques C, Tard guila F, Matos C, et al. Congenital cystic lesions of the biliary tree. Am J Roentgenol 2012;198:825–35.

Craig AG, Chen LD, Saccone GT, Chen J, Padbury RT, Toouli J. Sphincter of Oddi dysfunction associated with choledochal cyst. J Gastroenterol Hepatol 2001;16:230–4.

Kim MJ, Han SJ, Yoon CS, Kim JH, Oh JT, Chung KS, et al. Using MR cholangiopancreatography to reveal anomalous pancreaticobiliary ductal union in infants and children with choledochal cysts. Am J Roentgenol 2002;179:209–14.

Jang SM, Lee BS, Kim KK, Lee JN, Koo YS, Kim YS, et al. Clinical comparison of choledochal cysts between children and adults. Korean J Hepatobiliary Pancreat Surg 2011;15: 157–63.

Fitoz S, Erden A, Boruban S. Magnetic resonance cholangiopancreatography of biliary system abnormalities in children. Clin Imaging 2007;31:93–101.

Huang SG, Guo WL, Wang J, Sheng M, Lan XH, Fang L. Factors interfering with delineation on MRCP of pancreaticobiliary maljunction in paediatric patients. PLoS One 2016; 11:e0154178.

Tipnis NA, Dua KS, Werlin SL. A retrospective assessment of magnetic resonance cholangiopancreatography in children. J Pediatr Gastroenterol Nutr 2008;46:59–64.

Giefer MJ, Lowe ME, Werlin SL, Zimmerman B, Wilschanski M, Troendle D, et al. Early-onset acute recurrent and chronic pancreatitis is associated with PRSS1 or CTRC gene mutations. J Pediatr 2017;186:95–100.

Dai LN, Chen YW, Yan WH, Lu LN, Tao YJ, Cai W. Hereditary pancreatitis of 3 Chinese children: case report and literature review. Medicine (Baltimore) 2016;95:e4604.

Patel J, Madan A, Gammon A, Sossenheimer M, Samadder NJ. Rare hereditary cause of chronic pancreatitis in a young male: SPINK1 mutation. Pan Afr Med J 2017;28:110.

Wang W, Sun XT, Weng XL, Zhou DZ, Sun C, Xia T, et al. Comprehensive screening for PRSS1, SPINK1, CFTR, CTRC and CLDN2 gene mutations in Chinese paediatric patients with idiopathic chronic pancreatitis: a cohort study. BMJ Open 2013;3:e003150.

Lonergan GJ, Baker AM, Morey MK, Boos SC. From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics 2003;23:811–45.

Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics 2004;24: 1381–95.

Mekitarian Filho E, Carvalho WB, Silva FD. Acute pancreatitis in pediatrics: a systematic review of the literature. J Pediatr (Rio J) 2012;88:101–14.

Limwattana S, Dissaneewate P, Kritsaneepaiboon S, Dendumrongsup T, Vachvanichsanong P. Systemic lupus erythematosus-related pancreatitis in children. Clin Rheumatol 2013;32:913–8.

Carbonetti F, Iannicelli E, Federici M, Bucciarelli A, Pilozzi E, Conte E, et al. Primary pancreatic Burkitt lymphoma presenting as acute pancreatitis. J Gastrointest Cancer 2014;45(Suppl 1): S265–9.

Chung EM, Travis MD, Conran RM. Pancreatic tumors in children: radiologic-pathologic correlation. Radiographics 2006;26:1211–38.

Treepongkaruna S, Thongpak N, Pakakasama S, Pienvichit P, Sirachainan N, Hongeng S. Acute pancreatitis in children with acute lymphoblastic leukemia after chemotherapy. J Pediatr Hematol Oncol 2009;31:812-5.

Hijiya N, van der Sluis IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia. Leuk Lymphoma 2016;57:748–57.

Blejter J, Weller S, Pace R, Cusumano H, Giambini D. Autoimmune pancreatitis: an adolescent case and review of literature. J Pediatr Surg 2008;43:1368-72.

Rawla P, Bandaru SS, Vellipuram AR. Review of infectious etiology of acute pancreatitis. Gastroenterology Res 2017;10: 153-8.

Dutra P, Sanchez Candiani TM, de Oliveira SF, Mattos FF, de Carvalho IR. Acute pancreatitis in child with relapsing hepatitis a viral infection. J Clinic Med Case Rep 2020. doi: 10.31487/j.JCMCR.2020.02.04.

Chandak S, Mandal A, Singh A. Acute pancreatitis and pancreatic pseudocyst in a toddler following mumps, measles and rubella vaccine. Clin Pediatr OA 2017. doi:10.4172/2572- 0775.1000117.

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Published

2021-05-27

How to Cite

1.
Chittchang C, Laya BF, Kritsaneepaiboon S. Imaging of Pancreatitis in Children. J Health Sci Med Res [Internet]. 2021 May 27 [cited 2024 Apr. 20];40(1):95-109. Available from: https://he01.tci-thaijo.org/index.php/jhsmr/article/view/255355

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Review Article