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Children's Health

Pancreatitis

06/07/2011

Question:

my 15 year old son has had sharp pain on the left side of his body near his ribs and it goes all the way around to his back. he also has vomiting and dehydrating. the doctors have done urine test,cbc,ct scan,x-ray and checked his blood sugar(119).they tell me that they dont have a clue what is wrong with him. they sent him home with ibuprofen and flexeril. i am thinking it is pancreatitis. do u have any suggestions?

Answer:

There are several problems that could be present with left-sided pain, and certainly pancreatitis is one of them, especially if he is experimenting with beer and other alcoholic beverages or if he is overweight and taking medications to manage his fat intake. Pancreatitis is also associated with untreated gall bladder disease, which does tend to run in families. Pancreatitis can be acute or chronic. 

Unfortunately, chronic pancreatitis does not always result in blood test abnormalities. It is associated with a tendency to have high serum calcium levels and kidney stones. Hypercalcemia may also run in families. So if you have family members with kidney stone problems, it is worth telling his doctor about it. Pancreatitis is more common in males than females.

Left-sided pain may also stem from the spleen when it is enlarged in response to a problem in hemoglobin production or, more commonly, infection with mononucleosis, "mono" for short. The spleen can also swell if it is injured in a contact sport or a motor vehicle accident. An enlarged spleen is concerning because it is a blood-rich organ, which when injured can result in death from internal bleeding. I don't know if your son has complained of a sore throat and fatigue recently or not.

Another cause of left-sided pain is kidney infection or kidney stones. The urine test and CBC would have ruled out an infection but not stones. 

And a final common cause is constipation (hard stool that is difficult to pass) and diverticulitis (outpouchings in the bowel that can trap stool and become inflamed). Males are more likely to have diverticulitis.

An unlikely cause could be that your son has situs inversus in which the organs in the abdomen, and sometimes the chest as well, are on the wrong side of the body. This is often identified early in life but can be missed until a problem arises, such as appendicitis pain but on the left side rather than the right side.

Pain can also be referred from the chest to the abdomen. This is common in childhood. The pain could stem from a pneumonia where pus has formed and is pressing on nerves, causing pain. Pericarditis from systemic lupus erythmatosis or other connective tissue disorders may also cause referred pain.

So the best thing to do is to take him to his regular doctor and see if a referral to a pediatric GI specialist is recommended. His regular doctor is certainly able to competently diagnose and treat all of these problems, but s/he may prefer a referral to a specialist. As with any child, dehydration is a major threat to safety since children become dehydrated more easily than adults. So your son clearly needs follow up to identify the cause of the problem.

I hope this information is helpful and that the cause of the problem is quickly identified and treated.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University