Gallstone pancreatitis in adolescents.

During a 5-year period (1980 to 1985) in the Adolescent Unit at Bronx-Lebanon Hospital Center, 18 patients were admitted with the diagnosis of gallstone disease, four of whom, at the time of their admission, had associated acute pancreatitis. Although gallstone pancreatitis is infrequent in adolescents, it is an important differential diagnosis of upper abdominal pain in youngsters with gallstone disease. The most frequently encountered mechanisms of gallstone pancreatitis in adolescents appear to be impacted stones, congenital pathology in the ampullary area, and passage of small stones through the common bile duct, with temporary obstruction and inflammation followed by disruption of pancreatic ductules and/or acinar cell membrane. Proper management includes cholecystectomy and the mandatory performance of an intraoperative cholangiogram. Sphincterotomy or sphincteroplasty, which are frequently performed in adults with gallstone pancreatitis, should be avoided in adolescents. Even if impacted stones have to be removed at this age, papillotomy suffices. After an acute episode, a properly timed surgical treatment is curative.