Examination of two cases with severe motor and intellectual disabilities who died due to acute pancreatitis and review of the literature

Abstract

Background

Children with severe motor and intellectual disabilities (SMID) experience numerous serious physical health problems and comorbidities. Children with SMID require long-term care from a multidisciplinary team, including rehabilitation. Acute pancreatitis is a life-threating comorbidity in children with SMID. Risk factors for acute pancreatitis in patients with SMID include the absence of voluntary movement, requirement of respiratory devices, panhypopituitarism, thermoregulatory dysfunction, oral administration of valproic acid, gallstones, and low serum albumin levels.

Case presentation

We encountered two children with SMID who had been followed at our facility and hospital for an extended period. Both patients were at high risk for developing pancreatitis, particularly after undergoing ventilator support following tracheostomy and the introduction of gastrostomy feeding. In both cases, the diagnosis was triggered by changes in vital signs, such as an increase in heart rate, and confirmed by imaging findings consistent with acute pancreatitis. Both patients faced challenges with enteral nutrition after developing pancreatitis, as attempts to restart it led to relapse of pancreatitis. Ultimately, both patients experienced severe outcomes.

Conclusion

Efforts to prevent pancreatitis onset are crucial. When changes in a child's physical condition are suspected, especially in children with SMID who have risk factors, pancreatitis should be considered in the differential diagnosis. Regular blood tests should include serum amylase levels. Once pancreatitis is diagnosed, treatment should closely follow established guidelines. Additionally, all staff involved in the care of children with SMID should be aware of the prevalence of acute pancreatitis in this population.