Saturday, November 21, 2009

Is scoliosis surgery in your child's future? (By Etan Sugarman and Vishal Sarwahi, MD)

Acute Pancreatitis after Scoliosis Surgery
By Etan Sugarman and Vishal Sarwahi, MD
Spine Deformity Surgery Service
Department of Orthopaedic Surgery
Children's Hospital at Montefiore and the Albert Einstein College of Medicine

It is estimated that 14% - 30% of patients undergoing surgery for scoliosis develop acute pancreatitis in the immediate post-operative period. While a number of papers have been published, the cause is poorly understood and risk factors are not well established. Intra-operative blood loss, low body-mass index (BMI), calcium chloride administration, gastro-esophageal reflux (GERD) and reactive airway disease have been implicated. The incidence is largely felt to be similar in children with idiopathic and neuromuscular scoliosis.

Acute pancreatitis is defined as an acute inflammation of the pancreas. As the process develops pancreatic enzymes (amylase and lipase), normally secreted into the intestine to digest food, spill onto the pancreas itself and produce severe inflammation. Levels of these enzymes increase dramatically, and elevations greater than three times normal are considered diagnostic for acute pancreatitis. However, enzymes may also be elevated without any signs or symptoms, or may not be sufficiently elevated to make the diagnosis. In these instances an ultrasound may establish the presence or absence of acute pancreatitis.

Clinically acute pancreatitis presents as severe upper abdominal pain, tenderness, nausea, and vomiting. Treatment involves fluid hydration, resting the bowel, and adequate pain management. Data suggests that less than 1% of children will have long term complications. These include recurrence, chronic pancreatitis, and pancreatic pseudocysts and need follow up.

Acute pancreatitis has been well documented as a complication not only in spinal fusion surgery, but also in most abdominal surgeries, as well as cardiac and transplant surgeries. Awareness is the key. In our experience at the Children's Hospital at Montefiore, we have a lower than reported rate of post-operative pancreatitis. To minimize risk factors we employ a team concept early on in patient care, nutritional and GI consultation, blood conservation techniques during surgery and maintain heightened awareness especially in children with special needs. This coupled with a periodic clinical and laboratory evaluation help us detect acute pancreatitis early on in its course and helps decrease hospital stay and its impact on our patients and their families.

Source: Rett syndrome research trust

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