Çocukluk çağı pankreatitleri: 20 vakanın klinik analizi

Özet

Amaç: Çocukluk yafl grubunda pankreatitler çok s›k görülmemekte ve altta yatan risk etkenleri aç›s›ndan da eriflkinlerden farkl›l›k göstermektedir. Bu çal›flmada amac›m›z, pankreatit tan›s› ile izlenen hastalar›m›z›n belirgin özelliklerini ortaya koymakt›r. Gereç ve Yöntem: Son befl y›ll›k dönemde, klini¤imizde pankreatit tan›s› alan 20 hastan›n (19 akut, bir kronik pankreatit) hastalar›n klinik ve laboratuvar bulgular›, altta yatan risk etkenleri ve hastal›¤›n seyri geriye dönük olarak araflt›r›lm›flt›r. ‹statistik verileri, ortalama ±SD ve % ile ifade edilmifltir. Bulgular: Hastalar›n 14’ü k›z, 6’s› erkekti. Yafl ortalamalar› 11,4±3,62 (2-18) y›ld›. Saptanabilen risk etmenlerinin bafll›calar›, sistemik hastal›klar (%15), ilaçlar (%15), biliyer hastal›klar (%15) ve travma (%10) fleklindeydi. Yinelemelerle seyreden bir kronik pankreatit olgusu kistik fibroz tan›s› alm›flt›. ‹ki hastada yineleyen ataklar izlendi (birinde kabakulak serolojik bulgusu saptand›, di¤erinde herhangi bir risk etkeni saptanamad›). Ondokuz akut pankreatitli hastaya ait 22 akut atak de¤erlendirildi. Serum amilaz ve lipaz düzeyleri s›ras›yla hastalar›n %81,8 ve %90,9’unda yüksekti. Psödokist (%10), venöz tromboz (%10) ve nekrotizan pankreatit (%5) en s›k görülen komplikasyonlard›. Akut atak s›ras›nda ve izlemde kaybedilen hasta olmad›. Ç›kar›mlar: Sistemik hastal›klar, ilaçlar, biliyer hastal›klar ve travma çocukluk ça¤› pankreatitlerinin en önemli risk etkenlerini oluflturmaktad›r. Çocuklarda ölüm düflük olmakla beraber, özellikle fliddetli olgular, psödokist ve venöz tromboz gibi geliflebilecek komplikasyonlar aç›s›ndan yak›n izlenmelidir.

Abstract

Aim: Pancreatitis rarely occurs in childhood and the underlying causes differ from adults. The aim of this study is to evaluate the documentation of characteristics of our cases diagnosed as pancreatitis. Material and Method: Of the 20 patients (19 acute, one chronic) who diagnosed as pancreatitis in our clinic during a five year period were analyzed retrospectively, considering clinical and laboratory findings, underlying risk factors and outcome of the illness. Data were analysed with SPSS 16.0 computer package programme. Results: Of the 20 patients 14 were female and 6 were male. The mean age was 11.4±3.62 (2-18) years. The most common risk factors were systemic diseases (15%), drugs (15%), biliary diseases (15%) and trauma (10%). Nine of cases (45%) were idiopathic. One patient with chronic pancreatitis was defined as cystic fibrosis. Two patients had acute recurrent pancreatitis (one with mumps infection). Twenty-two episodes of 19 patients with acute pancreatitis were documented. The serum amylase and lipase were elevated in 81.8% and 90.9% of patients respectively. Pseudocysts (10%), venous thrombosis (10%) and necrotising pancreatitis (5%) were the major complications. None of the patients died. Conclusions: Systemic illnesses, drugs, biliary diseases and trauma are the major risk factors in childhood pancreatitis. Although the mortality rate is low in children, the patients should be considered by means of complication such as pseudocyst and venous thrombosis, especially in severe pancreatitis.