Ultrasonographic characterization and clinical analysis of pediatric pancreatitis patients in different ages / 中华胰腺病杂志

ABSTRACT

Objective:To assess the diagnostic value of ultrasound for pediatric pancreatitis in different ages via summarizing the ultrasonographic characterizations of pediatric acute pancreatitis (AP) and chronic pancreatitis (CP) patients in different ages. Methods:From January 2013 to June 2018, ultrasonographic images and related clinical data of 81 AP and CP children hospitalized in Children′s Hospital of Capital Institute of Pediatrics were retrospectively analyzed. Patients were divided into two age groups 0-5 and 5-18 years (23 and 58 patients respectively). The ultrasonography of 23 little children(≤5 years old) and 58 big kids (>5 years old) was compared.Results:All 23 little children were diagnosed as AP, including recurrent AP. 41 of 58 big kids (71%) were diagnosed as AP, and 17 (29%) were as CP. There were no significant differences between AP little children and AP big kids on the incidence of abnormal findings in pancreatic ultrasound, enlargement of pancreas, increased echogenicity of pancreas, heterogeneous pancreas, dilation of pancreatic duct, ductal calculus, calcification, unsmooth capsule of pancreas, increased echogenicity of peripancreatic tissue and peripancreatic fluid collection, pseudocyst, common bile duct dilatation and portal vein system thrombosis. Diffuse enlargement of the pancreas was seen more frequently in little children than big kids (88% vs 52%), while localized pancreatic enlargement occurred more often in big kids than little children (48% vs 13%), and both the differences were statistically significant ( P<0.05). Ultrasonography indicated that 9 (39%) little children with common bile duct dilatations were eventually diagnosed as choledochal cysts by surgery, while 6 (15%) of the 8 big kids with common bile duct dilatations were confirmed to be choledochal cysts by surgery, and the difference on the incidence of choledochal cysts was statistically significant ( P<0.05). All the CP patients were big kids. 47%(8/17) of CP big kids had parenchymal atrophy, 100%(17/17) had heterogeneous pancreas, 82%(14/17) had pancreatic duct dilation, 29%(5/17) had pseudocyst, 18%(3/17) had pancreatic calcification and ductal calculus. Conclusions:In ultrasonography for little children, the presence of congenital anatomy abnormalities, especially choledochal cyst, which can cause pancreatitis potentially, should be paid special attention to. In ultrasonography for big kids, overall scanning of the pancreas is necessary and the lesions in pancreatic body and tail should be carefully checked. Additionally, CP should be not be neglected in big kids.