Pancreatitis in a child: a challenging diagnosis,
Graham King1, Emer O'Toole1, Kevin O'Hare2, Barbara M. Ryan3, Basil Elnazir4, Shoana Quinn1
Author affiliations
Paediatric Gastroenterology, Children's Health Ireland at Tallaght, Dublin, Ireland
Pathology, Tallaght University Hospital, Dublin, Ireland
Adult Gastroenterology, Tallaght University Hospital, Dublin, Ireland
General Paediatrics, Children's Health Ireland at Tallaght, Dublin, Ireland
Correspondence to
Dr Graham King, Paediatric Gastroenterology Secretary, Tallaght University Hospital, Dublin D24 NR0A, Ireland; graham.king@hse.ie

http://dx.doi.org/10.1136/archdischild-2019-318287


A 13-year-old boy presented with a 4-day history of vomiting, jaundice, pruritus, pale stools and dark urine. He was apyrexic and had right-upper-quadrant abdominal tenderness. He had raised alkaline-phosphatase (620 U/L), gamma-glutamyl-transferase (435 U/L), total bilirubin (102 μmol/L), direct bilirubin (94 μmol/L), alanine-transaminase (123 U/L) and lipase (68 U/L), but normal amylase (37 U/L), faecal elastase (232 µg/g) and serum IgG4 levels.

Transabdominal ultrasound showed a distended gallbladder and dilated common bile duct (15 mm). He received prophylactic pancreatic enzyme supplementation, vitamin K, cholestyramine, rifampicin and …