Pancreatitis in Young Children

Pancreatitis is rare in very young children and the medical literature contains comparatively few accounts of the associated pathology.The purpose of this paper is to describe the findings in the pan- creas in four cases in which disease of this gland was discovered at autopsy and to discuss the patho- genesis of the condition.Three of the children concerned were Bantu of N. Rhodesia and were the only ones found to have pancreatitis in the routine examination of material from 100 consecutive autopsies on African children.The fourth child, included for comparison, was an Edinburgh girl and the only case of pancreatitis in the records of 1,812 consecutive post-mortem examinations conducted during the five years 1952-56 by the staff of the Pathology Department of the Royal Hospital for Sick Children, Edinburgh.Case Histories Case 1.A female Bantu child, aged 18 months and weighing 13 lb.4 oz., was admitted to the African Hospital, Luanshya, where she was found to have bronchopneumonia, diarrhoea and vomiting (of several days' duration) with marked dehydration and kwashior- kor of moderate severity.She responded well to treatment but relapsed on the eighth day with further vomiting and diarrhoea for which she again required parenteral fluids.Soon after resuming oral feeding she suddenly collapsed and died in less than three hours.At necropsy the typical appearance of an acute haemorrhagic pancreatitis was found with haemorrhage extending for a considerable distance in the retro-peritoneal tissues both proximally and distally to the pancreas.Fat necrosis was not obvious and no abnormality was present in gall bladder, bile ducts or the terminal portion of the main pancreatic duct.On microscopical examination of the pancreas, the most striking changes were in the interlobular ducts most of which were dilated, some to a remarkable extent, while many contained eosinophilic material which had com- pletely occluded the lumen.This material had often a distinctly laminated appearance and was sufficiently soft to be readily cut by the microtome knife, although tearing of the tissues in the immediate vicinity had occurred in some instances (Fig. 1).The epithelium lining some of these occluded ducts was unusually tall and columnar, and was occasionally more than one cell layer in thickness, but squamous metaplasia was not present in any of numerous sections examined.In a few ducts rupture of the wall had occurred with herniation of the contents and in these situations there was a varying degree of round cell infiltration, many of the cells being polymorphs, but elsewhere the dilated and occluded ducts did not appear to have excited any significant reaction, only a very few lymphocytes being found in their walls and immediate surroundings.The main pancreatic duct was normal.Haemorrhage, although widespread, was confined FIG.I.-Case 1. Dilated and ruptured intralobular duct filled with inspissated secretions.(H. and E. x 70.)