P0156 - An Unusual Case of Recurrent Acute Pancreatitis in a Pediatric Patient: A Case Report

Udit Asija, MD¹, Ahmed Chatila, MD², Tejas Nikumbh, MD¹, Naeem Ijaz, MD¹, Maria Rose Dominic, MD³, Lakshmi Priyanka Pappoppula, MD³, Mashu Shrivastava, MD³, Sandeep Mandal, MD³, Syed Muhammad Hussain Zaidi, MD³, Usman Rana, MD⁴, Sanya Badar, MD⁵, Seyma Bayram, MD¹, Muhammad Hassan Shakir, MD³, Apeksha Kakkar, MD³, Eric Goldberg, MD⁶, Vikas Khurana, MD^1
1The Wright Center for Graduate Medical Education, Scranton, PA; ²University of Pennsylvania Health System, Philadelphia, PA; ³The Wright Center for Community Health, Scranton, PA; ⁴The Wright Center for Graduate Medical Education, Scanton, PA; ⁵Wright Center for Graduate Medical Education, Scranton, PA; ⁶University of Maryland Medical Center, Baltimore, MD

Introduction: Recurrent acute pancreatitis in pediatric patients poses significant challenges, characterized by repeated episodes of pancreatic inflammation despite resolution between attacks. Understanding its etiology, risk factors, diagnostic approaches, and tailored management strategies is crucial for optimizing outcomes and mitigating long-term pancreatic dysfunction.

Case Description/Methods: A 5-year-old male with a history of Molluscum contagiosum presented with sudden onset abdominal pain, nausea, and bilious emesis following trauma during taekwondo practice. On examination, he appeared distressed, pointing to his umbilicus, with epigastric tenderness and guarding. Laboratory tests showed elevated lipase 3313 U/L, amylase 437 U/L, leukocytosis 16,500 cells/mm³, and lactic acidosis. CT abdomen revealed pancreatic parenchymal disruption and peri-pancreatic fluid. Later, it was discovered the patient had been going to taekwondo practice where the likely trauma occurred. Further evaluation with MRCP confirmed grade 3 pancreatic neck injury and duct disruption. ERCP demonstrated a stent placed for pancreatic duct drainage. The patient recovered but presented twice with emesis, requiring repeat ERCP due to pancreatic stricture and stent occlusion. Genetic testing revealed SPINK1 mutation predisposing to pancreatitis. Subsequent ERCPs managed stent complications, and the patient was discharged on pancrelipase.

Discussion: Understanding genetic predispositions like SPINK1 mutations is crucial for personalized management of pancreatitis. SPINK1 mutations alter trypsin inhibition, increasing susceptibility to pancreatitis triggers like trauma in our case. Management strategies should involve multidisciplinary care with consideration of genetic factors, trauma severity, and treatment outcomes, emphasizing tailored approaches to optimize long-term pancreatic health. Endoscopic management of high-grade pancreatic injuries in children remains contentious, especially in cases involving pancreatic duct disruptions. Our case advocates for managing such injuries endoscopically versus surgically. Endoscopic interventions like stent placement and ductal repair can preserve pancreatic function but may lead to prolonged hospitalization and increased complication rates, including pseudocyst formation. Further research is needed to refine treatment protocols and improve outcomes for pediatric patients with rare genetic predispositions to pancreatitis.


Disclosures:


Udit Asija, MD¹, Ahmed Chatila, MD², Tejas Nikumbh, MD¹, Naeem Ijaz, MD¹, Maria Rose Dominic, MD³, Lakshmi Priyanka Pappoppula, MD³, Mashu Shrivastava, MD³, Sandeep Mandal, MD³, Syed Muhammad Hussain Zaidi, MD³, Usman Rana, MD⁴, Sanya Badar, MD⁵, Seyma Bayram, MD¹, Muhammad Hassan Shakir, MD³, Apeksha Kakkar, MD³, Eric Goldberg, MD⁶, Vikas Khurana, MD¹. P0156 - An Unusual Case of Recurrent Acute Pancreatitis in a Pediatric Patient: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.