The role of ERCP in the treatment of recurrent acute pancreatitis.

Abstract

Introduction: The incidence of acute pancreatitis is increasing in the pediatric population. Up to 35% of children have recurrence secondary to anatomical variations of the pancreatic duct. In this context, endoscopic retrograde cholangiopancreatography (ERCP) stands as a key diagnostic and therapeutic tool.

Clinical case: We present two cases of recurrent acute pancreatitis (RAP) in 2 adolescents aged 14 and 15 years old. Apart from small gallstones in the gallbladder in one of them, bile duct or pancreatic duct disorders were not identified at either ultrasonography or nuclear magnetic resonance cholangiopancreatography (NMRCP). In both cases, diagnosis was established through ERCP, with two ERCPs required in each case before accurate diagnosis was achieved. ERCP had to be repeated as a result of technical issues in one case, and due to lack of relevant findings in the other. RAP episodes ceased after plastic prostheses had been placed in the pancreatic duct.

Discussion: TAnatomical variations of the pancreatic duct are a cause of RAP in the pediatric population. ERCP allows diagnosis to be established even when regular imaging studies are not conclusive.