ABSTRACTS: Poster Session Abstracts
Introduction: Management of pancreatitis involves resting the pancreas to reduce secretion of pancreatic enzymes1. Nutritional support is therefore an essential component. Although studies in adults have concluded that enteral feeding is more beneficial than parenteral2, there have been no similar studies in children. Previous experience at this centre has shown that jejunal feeding in such cases can be problematic, however, guided by the clinical literature, this is what we aim for.
Methods: During the year 2003, 4 children (8 to 15 years) with acute pancreatitis were all admitted within a 10-day period. The aetiology of pancreatitis was: gallstones (n=1); trauma (n=1); pancreas divisum (n=1); idiopathic (n=1). They were reviewed daily by a multiprofessional team comprised of doctors, surgeons, dietitian, pharmacist and nutrition nurse. Nasojejunal feeding was started twice in one child whose symptoms appeared less severe, but both times was discontinued due to pain and raised amylase levels. Insertion of nasojejunal tubes in two others failed (endoscopic n=1; radiological guidance n=1) and was not pursued with the fourth, therefore full enteral nutrition was not attained. Parenteral nutrition was administered to all(median 5(range 3–8) days after admission)once central intravenous access was established, and was continued for a median 28 (range 9–40) days. There were no complications associated with its use.
Results: All had extended periods of pain, nausea and vomiting resolved by intervention. Three developed pancreatic pseudocysts (n=3) as a complication. Intervention included laparo-scopic cholecystectomy (n=1), CT-guided cyst drainage (n=1), therapeutic endoscopic retrograde cholangiopancreatography (ERCP) (n=3) and surgical insertion of hickman line (n=3).
Conclusion: All 4 children made a full recovery, tolerating normal diet by discharge, with no significant weight change. They remained in hospital for a median 40 (range 26–45) days. We were unable to establish jejunal feeding in our cohort of patients, but pain might have been a contributory factor. Parenteral nutrtion is associated with higher risk factors, however, if managed by an effective nutrition team, complications can be prevented. In our experience, jejunal feeding should be avoided in children with ongoing symptoms such as abdominal pain or vomiting.
1. France S. (2001) The Liver and Pancreas in
Shaw V. and Lawson S. (2nd ed) Clinical Paediatric Dietetics Blackwell Science: Great Britain
2. Windsor A. et al (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis Gut 42 (3) 431–5