A review of acute pancreatitis in the era of COVID-19

Abstract

Acute pancreatitis is uncommon in childhood with an estimated incidence of approximately 1 in 10,000 children per year. It is an important condition, which may escape prompt diagnosis and is associated with significant morbidity and mortality. Most often, it will result in an acute hospital admission. The course of this disease is unpredictable and ranges from self-resolving mild illness to significantly severe disease with high risk of mortality or complications due to progression to multiorgan failure. Considerable advances have occurred in management which is now focused on multidisciplinary approach with extensive investigation and minimally invasive endoscopic interventions resulting in improved prognosis. In recent years, incidence of acute pancreatitis in children has risen, either due to improved awareness or reflective of true rise. Since 2020 there are emerging data suggesting an association of COVID-19 with acute pancreatitis. The best approach to diagnosis and management of acute pancreatitis in children and young people is largely extrapolated from adult practice. This review presents a brief summary of normal physiology and pathophysiology relating to pancreatitis, a suggested approach to investigation and diagnosis and summarizes available evidence to inform management in children and young people. We will also explore the latest data collected linking COVID-19 to pancreatitis.

Keywords: COVID-19; diagnosis; disease pathogenesis; epidemiology; genetics; paediatric pancreatitis.

Figure 1

US abdomen: selected US image in axial plane demonstrates pancreas. The pancreatic head overlies the IVC, which has increased echogenicity and irregular outline, in comparison to body and tail which are homogenously hypoechogenic, a feature seen in pancreatitis. P = pancreatic head, IVC = inferior vena cava. Anonymized image shared with consent of the patient.

Figure 2

SC pancreatic necrosis annotated: IV contrast enhanced image through pancreas demonstrated necrosis in pancreatic body and extensive peripancreatic inflammatory changes. P = pancreatic head, L = liver, S = spleen. Anonymized image shared with consent of the patient.

Figure 3

Pancreatic pseudocyst: IV contrast enhanced images of same patients 3 weeks later. Now there is well defined hypodense collection in the regions corresponding to previously seen inflammatory changes, features consistent with pseudocyst formation. Anonymized image shared with consent of the patient.