Acute pancreatitis.

The etiology of acute pancreatitis in children is widely varied and includes idiopathic, drug-related, congenital, and posttraumatic causes. Most children have abdominal pain and tenderness without evidence of peritonitis, and most patients will have elevated serum amylase levels initially or after a delay of about 12 hours. If the diagnosis remains equivocal or in the setting of trauma, an abdominal CT scan should be obtained. Initial treatment for all forms of acute pancreatitis includes bowel rest and support with intravenous fluids. A nasogastric tube should only be placed for symptomatic relief and prophylactic broad-spectrum antibiotics should be given only in the setting of necrotizing pancreatitis, especially if patients are receiving pharmacologic immunosuppression. Fever or decline in clinical status should prompt CT scan with intravenous contrast and possible fine needle aspiration to detect the presence of sterile or infected necrotizing pancreatitis. Positive cultures or severely worsening clinical status are indications for necrosectomy and debridement with sequential packing and explorations. All patients who have had an episode of gallstone pancreatitis should have a cholecystectomy after resolution of pancreatic inflammation but before discharge from the hospital.