*2.1.4 Trauma*

*Pancreatitis*

**2.1 Etiology**

*2.1.1 Infections*

*2.1.2 Congenital abnormalities*

**Common Less common Rare**

Medications Genetic/hereditary

*Causes of acute pancreatitis in children.*

Biliary disorders Infections Autoimmune pancreatitis

Systemic conditions Metabolic diseases Anatomic pancreatobiliary abnormalities

100,000 per children per year, which is within of the range of incidence reported for adult AP. Genetic contributions to the development of pancreatitis, especially in acute recurrent and chronic pancreatitis are now increasingly recognized. There are no evidence-based diagnostic guidelines for pancreatic disorders in children. The diagnosis criteria are based on symptoms, biochemical and imaging evidence of pancreatitis, with two of the three criteria required to diagnose AP. A multicenter effort led by INSPPIRE (INternational Study Group of Pediatric Pancreatitis: In Search for a CuRE) defined AP as requiring 2 of: (1) abdominal pain compatible with AP, (2) serum amylase and/or lipase values ≥3 times upper limits of normal, (3) imaging findings consistent with AP. Although abdominal pain is the most common clinical manifestation, it may be absent in up to one third of pediatric patients. The diagnostic yield and concordances for serum pancreatic enzymes and imaging for the diagnosis of pediatric AP will be discusses. Pediatric AP is associated with significant disease burden. There is currently no consensus on the definition for severity of AP in children. However, there are now predictors of severity for AP that has been developed and validated in children. The management of AP remains driven by adult studies and recommendations. Treatment is directed at the underly-

While alcohol and gallstones represent the main causes of acute pancreatitis in adult population, the etiological scenario of acute pancreatitis is mostly due to drugs, infectious diseases, congenital abnormalities or trauma (**Table 1**). Furthermore etiological factors may vary considerably according with ethnicity.

Pediatric acute pancreatitis is associated with paramyxovirus or mycoplasma infections. Mumps virus induces parotitis and orchitis in pediatric population and may be complicated by meningoencephalitis or pancreatitis. In the latter case clinical manifestations are represented by usually self-limiting diarrhea and abdominal pain. Mycoplasma infection-related pancreatitis can be distinguished into two types: early onset type and late-onset type following respiratory tract symptoms beginning. This different onset spectrum is due to a direct injury of mycoplasma into the acinar cells in the former type while to an autoantibodies targeting in the latter [2].

Chole-dochal cyst constitutes the most principal cause of AP. In case of abnormal junction between pancreatic and biliary ducts the sphincter of Oddi encircles

ing etiologies as well as supportive measures.

**68**

**Table 1.**

Trauma Idiopathic

Pediatric pancreatic injuries are uncommon and can be mostly ascribed to vehicle accidents. Anyway because of its retroperitoneal location pancreas is preserved in case of minor abdominal traumas and a pancreatic transection can occur clinically silent [6].
