Cholecystocholedocholithiasis as a cause of acute necrotizing pancreatitis in children

Abstract

   Aim. To improve treatment outcomes for acute biliary pancreatitis in children with cholecysto- and choledocholithiasis.   Materials and methods. The authors conducted a retrospective analysis of the examination and treatment of 14 children aged 3–17 years with moderate and severe ABP. In 11 observations (78.5 %) the period from the onset of the disease to hospitalization comprised < 24 hours, in 3 observations (21.4 %) > 48 hours. All patients underwent a comprehensive examination including clinical, laboratory and instrumental diagnostics.   Results. Ultrasound signs of acute cholecystitis were detected in 10 children (83.3 %), biliary hypertension – in 12 (85.7 %). Laparoscopic cholecystectomy was performed in 1 patient (7.14 %) within 72 hours from the onset of the disease; 1 child underwent open cholecystectomy with lithoextraction and drainage of the common bile duct according to Kerr technique. Open cholecystostomy with drainage of purulent-necrotic parapancreatitis was performed in 1 case. Endoscopic papillosphincterotomy, lithoextraction and cholangiography were performed in 4 children (28.6 %), 1 child additionally underwent stenting of the common bile duct and pancreatic duct. All patients were diagnosed with necrotizing pancreatitis and various types of parapancreatitis. Drainage of parapancreatitis in the Vladimirsky Moscow Regional Research Clinical Institute was performed in 5 (35.7 %) children: 2 (14.3 %) by open technique, in 2 (14.3 %) by laparoscopic sanation and in 1 by US-guided percutaneous drainage.   Conclusion. Emergency endoscopic papillosphincterotomy with lithoextraction refers to a method of choice for the elimination of biliary hypertension in choledocholithiasis. Delayed or elective cholecystectomy is considered preferable for children with severe or moderately-severe acute biliary pancreatitis. The choice of drainage technique for infected parapancreatitis depends on the spread and sanation quality of purulent process.