The two series of childhood pancreatic disorders from India were not referred to in this manuscript due to oversight. We acknowledge their contribution to childhood pancreatic disorders.

Diagnosis of acute pancreatitis was based on raised serum amylase levels with or without usG and/CT scan findings. In the 7 cases of acute pancreatitis with normal serum amylase levels (as shown in Table II), diagnosis was based on USG and or CT scan findings. In cases with normal USG and CT scan, serum amylase levels were very high, and were used as criteria to diagnose acute pancreatitis. As already indicated in the text, serum lipase levels were not available in all the patients.

Pi phenotyping by isoelectric focusing for alpha-1-antitrypsin deficiency was not available at the time of publication of this manuscript. A suspicion of alpha-I-antitrypsin at our center was based on either absent alpha-1-globulin band and/reduced serum AAT levels (Methodology Section). We do accept the limitation of diagnostic tests of alpha-1-antitrypsin deficiency. Pi phenotyping is now a routine screening test for detecting alpha-1-antitrypsin deficiency at our center.

We observed trauma to be associated with chronic pancreatitis in 2 patients. On review of files, these 2 patients with evidence of trauma had initial symptoms like acute pancreatitis and continued to have repeated episodes of acute pain till they presented as chronic pancreatitis at our center. There are previous reports to support the association of trauma with chronic pancreatitis. This was already quoted in the article.

We have come across case reports in the literature of association of tuberculosis with acute pancreatitis(1). In our study also, we observed tuberculosis as an etiology for acute pancreatitis in 2 patients.

Valproate was observed as a cause of chronic pancreatitis in one patient with history of valproic intake for more than 6 years. There are reports in literature suggesting the presence of chronic pancreatitis related to prolonged use of valproic acid(2 3).

Laparotomy in the 9 cases of acute pancreatitis was done for blunt trauma(3), bile leak(1) and for diagnostic purposes(5).

N.K. Arora,
Anjali Ahuja,
Department of Pediatrics,
All India Institute of Medical Sciences,
New Delhi 110 029, India.
E-mail: [email protected]

1. Redha S, Suresh Rl, Subramanian J, Merican I. Pancreatic tuberculosis presenting with recurrent acute pancreatitis. Med J Malaysia 2001; 56: 95-97.

2. Cooper MA, Groll A. A case of chronic pancreatic insufficiency due to valproic acid in a child. Can J Gastroenterol 2001; 15: 127-130.

3. Taira N, Nishi H, Mano M, Waki N, Tsugita Y, Takashima S, et al. Pancreatitis induced by valproic acid: report of a case. Surg Today 2001; 31: 1027-1031.