Abdominal ultrasound in the diagnosis and management of recurrent pancreatic pseudocyst in children – case report

Abstract

Material and method: A 9 years old girl who had no relevant family or particular previous medical history and abdominal trauma was admitted for intermitent epigastric pain lasting for several months: inappetence, postprandial nausea and vomiting, early satiety, constipation and weight loss. Physical examination revealed an undernutrition girl (BMI=12.3; P<5), no fever, upper abdominal tenderness and fullness, without definite mass. Transabdominal ultrasound showed a large anechoic, oval, unilocular, weel-defined mass, with smooth wall, in the left upper abdominal quadrant. Abdominal CT identifies a thick-walled, fluid-filled homogenous (10–20 HU) mass, adjacent to the body and tail of the pancreas, with 9cm bipolar diameter, which greatly distorted the stomach, and extended to the spleen and left kidney, without adenopathy or ascites. Laboratory tests revealed normal complete blood count, without inflammatory syndrome, normal biochemical tests, except mild hiperamylasemia (x2N). She was diagnosed with pancreatic pseudocysts and after four weeks she was surgically drained for 14 days, with uneventful course. Ultrasound examination two months after surgery was normal. After eight months she was readmitted for the same symptoms. Ultrasound and abdominal CT sacn confirmed the relapse of pancreatic pseudocyst with the same location and extent, with thicker, denser wall and nonhomogenous content. The pancreatic pseudocyst persisted after two months of ultrasonographic monitoring, with smaller diameter (about 4cm) and normal amylasemia.