Evaluation Of Baseline For Pediatric Abdominal Pain In Pakistan

The aim of our study was to define a baseline for pediatric AP in Pakistan by describing its etiology, presentation, complications and outcome among all cases of primary disease diagnosed at our unit.

Majority of our patients were females (51. 2%) while males were 48. 8%. Female propensity for AP has been shown recently by Jha PK et al 6. Gullo et al found males to be more affected from the disease as compared to females 7. Mean age of our patients was 7. 97±3. 5 years with age range of 2-16 years. Majbar and fellows recorded mean age of 11. 2 years with age ranging from 1. 3-14. 9 years 8. The most common symptoms in our study were abdominal pain & vomiting (97. 4%), which is confirmed by previous studies 9, 10. Fever was observed in only 20. 5% of our patients. Sanchez-Ramirez et al documented fever in 27% patient, however, fever ranging from minimal of 3. 8% of included pediatric participants to as high as 40% has been documented by different studies 9, 11, 12.

The major clinical associations of our cohort are shown in table 2. We could not discern the cause of AP in 11 (28. 2%) children and labeled them as idiopathic. Similar to our study, Majbar et al labeled 37% of his cohort having AP due to idiopathic cause, others have conflicting results. Grzybowska-Chlebowczyk et al, Antunes et al and Pant et al have found biliary aetiology (30%, 24. 3% & 30% respectively) as leading cause of AP in their studies 9, 13, 14. However, other studies also have mentioned idiopathic etiology leading cause of pediatric AP with a range from 34 % to 43. 1% 15, 16. Metabolic causes were the second most common cause in our cohort while hepatobiliary causes leading to AP were responsible only for 15. 3%. Complications of AP can be described as early onset or late onset. Acute complications are usually pneumonia, pulmonary effusions, shock or renal failure. Late onset complications include pancreatic necrosis, pseudocysts, recurrent pancreatic & chronic pancreatitis 17. Pancreatic pseudocyst complicated 30. 7% of our patients followed by hemorrhagic ascites (7. 6%). Fayyaz et al documented 46. 15 % of their cohort complicated by pseudocyst while ascites was also present in 19. 24% in their patients 18. Others have reported much less incidence of both entities, pseudocysts ranging from 10-20% while ascites has been documented as low as 1-3. 4% 11, 19. Majority (92. 3%) of our patients recovered from AP while 7. 7 % expired eventually. Fayyaz et al AP outcome was similar to ours but Alabdulkareem and fellows had no reported expiry in their study.

The limitations of the study are lack of advanced diagnostic facilities and absence of mutational analysis which lead a major chunk of patients being labeled as idiopathic. A limited number of included children emphasizes the need to conduct a large multicenter studies in order to evaluate the etiology, complications and outcome of pediatric AP in our country in a more convincing way.

Conclusion

Females were more commonly affected than males by AP. Abdominal pain and vomiting are major presenting symptoms of the disease. Most of cases were due to idiopathic etiology. Common complication was pseudocyst formation and hemorrhagic ascites. Pediatric AP is usually classified as mild and carries a good prognosis.