Background: The diagnosis of pediatric pancreatitis has been increasing over the last 15 years but the etiology of\nthis is uncertain. The population of pre-adolescent patients with pancreatitis in the emergency department has not\nbeen specifically described. Our objective was to determine the characteristics of these patients to illuminate this\npopulation and disease in order to better identify them and avoid a delay in diagnosis and treatment.\nMethods: This was a retrospective descriptive study of consecutive pediatric patients under the age of 13 years\nbetween 2006 and 2016 who presented to our pediatric emergency department with a diagnosis of atraumatic\npancreatitis. Patient characteristics, lab and imaging results, identified etiology of pancreatitis, and recurrence rates\nwere recorded and evaluated.\nResults: There were 139 visits, of which 85 were for a first episode of acute pancreatitis, and 54 were patients with\nan episode of recurrent pancreatitis. The median age for all visits was 8 years (IQ range 5â??11). Of the acute cases,\n26% had uncertain or undetermined etiologies of which half were thought to likely be viral related; 20% had systemic\ninflammatory or autoimmune diseases; 19% were associated with medications, with the most common being valproic\nacid; 16% were cholelithiasis-related; and 15% were found to have a genetic, congenital or structural etiology.\nNo patients had elevated triglycerides. Those with cholelithiasis and genetic or structural defects were found\nto have a higher recurrence rate than those with other etiologies. There were only four patients diagnosed\nwith chronic pancreatitis.\nConclusions: The etiology of pancreatitis in pre-adolescent children has a different distribution than in adolescents\nand adults, with gallstone disease less frequent and concurrent contributing illness more common. Patients\non pancreatitis-causing medications or with known genetic risk or structural pancreatic problems should be\ntested for pancreatitis if presenting with concerning symptoms. Hypertriglyceridemia and chronic pancreatitis\nwith evidence of pancreatic exocrine insufficiency is uncommon in this population.
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