Özet:

Mr. Editor, Oya Balcı and ark.I read with interest the presentation of the facts entitled "Acute Pankreatitis: The Presentation of the Facts After the Use of Rufinamide" published in the third edition of the 2016 Journal of Contemporary Medicine (Journal of Contemporary Medicine 2016;6(3);231-233) with interest. This article is a valuable study that emphasizes that acute pancreatitis can also develop related to rufinamide, one of the antiepileptic drugs. We also want to summarize an acute pancreatitis associated with rotavirus infection that we have previously observed in the Child Gastroenterology, Hepatology and Nutrition Unit of the Child Health and Diseases Department of the Selçuk University of Medicine in order to emphasize the need to be cautious in the direction of acute pancreatitis. It was learned that the 10-year-old male patient, who was deposited with a durable stomach pain, persistent vomiting and severe diarrhea (boll water, 15-16 times/day) for about 10 days, had no history and any characteristics related to his history, and that he did not use any medication before he applied to us. In the examination of the patient with a common sensitivity in the examination of the palpation with the abdominal examination, rotavirus antigen was found positive while the full blood count, erythrosite sedimentation rate, full urine examination, CRP and blood biochemistry (glycosis, urine, total protein, albumin, creatine, electrolytes, uric acid, LDH, AST, ALT, GGT, ALP, bilirubins, lipase and amylase) were normally evaluated. In the radiological examination, no pathological findings were found in the abdominal ultrasound (USG). When monitored with parenteral fluid support treatment for the treatment of rotavirus gastroenteritis, the USG examination of the abdomen on the increase in stomach pain on the third day of treatment was normal while the levels of serum amylase and lipase in the blood biochemistry were 3 times higher than the upper limit of the normal (lipase, 201 U/L; normal values, 7-78 U/L). With the pre-diagnosis of acute pancreatitis, oral nutrition was interrupted and nazogastric decompression and parenteral nutrition support began. 5 in the hospital. Typical clinical findings on the day serum lipase level reached approximately 14 times the upper limit of the normal (1086 U/L) (symptom of abdominal pain spreading to the back in the shape of the stomach), on the basis of 3 times higher levels of pancreatic enzymes than the upper limit of the normal, and on the basis of the detection of the heterogeneous appearance of the pancreast in the USG study of the stomach, (2) acute pancreatitis was diagnosed. The recommended (3.4) octreotid infusion treatment for use in the treatment of acute pancreatitis has begun as a result of reduced pancreatic secretions (1 μg/kg/hour x 3 days + 0.5 μg/kg/hour x 4 days). In the blood biochemical study for the etiology of acute pancreatitis, hypertriglyceridemia or hypercalcemia were not identified, as in the MRCP image, anatomical and viral serological studies were not found any other underlying cause except rotavirus infection. In 7 days after the treatment began, the patient, who was corrected by reducing the symptoms of abdominal pain and returned to normal limits by reducing the levels of pancreatic enzymes, was released after the oral diet was passed and was called for control on the failure to repeat the table. Rotavirus is an ethical cause that may cause acute gastroenteritis in children, but in literature, infections of other organs such as rotavirus-related menengoensephalitis or pancreatitis have also been (5,6). A high amylase may be observed in patients with acute gastroenteritis (7). However, the level of lipase in our patients is also 3 times higher than the upper limit of the normal, the radiological examination (USG) has diagnosed the heterogeneous appearance of the pancreas that supports pancreatitis and the abdominal pain that is compatible with acute pancreatitis according to international diagnostic criteria (2) acute pancreatitis has been diagnosed (Table 1). Table of 1. Criteria for the diagnosis of acute pancreatitis (2) The presence of the following 3 criteria; 1.                  Pain in the abdomen compatible with acute pancreatitis 2.                  Serum amylase and/or lipase levels are 3 times higher than the normal top limit. Detection of findings that support pancreatitis in radiological examinations (ultrasonography, magnetic resonance imaging or computer tomography) Also, all other causes (infectious, obstructive, metabolic, autoimmune, traumatic) that may have a role in the etiology for the diagnosis of acute pancreatitis associated with rotavirus infection are also excluded. As a result, the acute pancreatitis picture associated with rotavirus infection may develop. It is very important to remember that in patients with the cause of rotavirus gastroenteritis, stomach pain can develop not only due to the table of gastroenteritis, but also due to acute pancreatitis.

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