Acute pancreatitis is a rare entity among pediatric population, whose incidence has increased in the last two decades. However, there are few studies on this condition, so its therapeutic management is unsteady, especially in severe cases. In this article, we describe our experience in a pediatric intensive care unit in the management of 3 clinical cases with pancreatitis occured in the last months. We applied the guidelines extracted from the clinical guides about management of acute pancreatitis in adult patients, based on improving analgesia, administration of intensive fluid therapy and initial pancreatic rest with early reintroduction of enteral nutrition, which showed a good subsequent clinical evolution. Our main purpose, given the increase in the incidence of this entity, is to emphasize the importance of a high level of clinical suspicion when facing a case of abdominal pain that may allow an early diagnosis and a quick establishment of a proper treatment in these cases, as well as to highlight the most important facts of its management.

Introduction: Acute pancreatitis is an unusual disorder in childhood that commonly onsets with sudden abdominal pain. Our goal is to describe the features of the patients diagnosed of acute pancreatitis between 1988 and 2008 who were admitted to our hospital.

Methods: Retrospective observational study by review of medical records. We collected data referred to epidemiology, aetiology, clinical symptoms, analytical (amylase, lipase) and radiological findings, medical treatment administered and outcome.

Results: We included 27 patients (66% males), with a mean age of 7.2 years (range: 6 months-16 years). 52% of them suffered from chronic diseases. The most common cause was a structural anomaly (37%). Other aetiologies included: drugs, infections, shock and immunodeficiencies. 26% of cases were catalogued as idiopatic. The presenting symptom in non-critical patients was abdominal pain, in different areas and with diverse features, associated with vomiting (55%), fever (33%), anorexia (19%) and other symptoms related to the aetiological agent. Pancreatic enzyme levels were elevated in all patients. The most widely used radiological test was ecography (abnormal in 74%), being the most common image the enlargement of the gland. 89% of patients were managed conservatively with complete bowel rest during a median of 48 hours. ERCP was indicated in 2 patients to treat coledocolitiasis. Median hospital stay was 9 days, with favourable outcome in 40% of patients. Recurrence was described in 3 patients and 6 died because of non-digestive causes.

Conclusions: Acute pancreatitis is an unusual disease in childhood with a great variety of aetiological factors that determine different prognosis.

Acute pancreatitis (AP) in childhood is used to present with high levels of amylase, although in certain situations it usually occurs with normal values.

We present the case of a patient who was admitted with a nonspecific symptom of fever, irritability and drowsiness, whose diagnosis of pancreatitis was an intraoperative finding. Serum amylase levels were normal, remaining high, however, levels of lipase.

From this case, we reviewed the literature of the elevation of amylase ad lipase levels in the context of AP in pediatric age.

Acute pancreatitis occurs less frequently in children compared with adults. However, recent studies have suggested that its incidence may be increasing. Once it is diagnosed the treatment of these patients is based on nutrition support. There are few prospective studies in children, therefore the physicians are obliged to use validated adult guides.Our objective is to review the knowledge on nutrition support in pediatric patients with acute pancreatitis and suggest a guide for the management of these patients.