Surgical disorders of the pancreas in infancy and childhood.

Pancreatic disorders in infants and children encountered over a 20 year period are reviewed. A total of 79 children were treated. Forty-eight had pancreatitis or its complications, 17 had congenital malformations, 12 had hypoglycemia and hyperinsulinism, and 2 had carcinoma. The mortality rate for the children with pancreatitis was 17 percent and was limited to patients treated nonoperatively. Idiopathic and drug-induced pancreatitis (the latter, particularly from corticosteroids) were the predominant types. Only rarely should such patients undergo operative treatment. Operations performed for various obstructive or traumatic lesions of the pancreas, as well as for complications of pancreatitis, obtained uniformly good results. The most common congenital malformation of the pancreas was an annular pancreas in association with duodenal atresia; all children with this abnormality were successfully treated with bypass procedures. Four patients with an ectopic pancreas underwent successful wedge resection. Nine infants with nesidioblastosis or islet cell hyperplasia and three children with islet cell adenomas underwent successful resection without any deaths, although neurologic sequelae due to prolonged preoperative hypoglycemia were common. Two patients underwent radical resection for pancreatic carcinoma, one of whom had survived 20 years postoperatively at last follow-up. Pancreatic disorders requiring operation in childhood are uncommon, but are likely to be complex and challenging when they do occur.