Endoscopic stenting for chronic recurrent pancreatitis in a child.

Abstract

Chronic pancreatitis in childhood is a rare but potentially debilitating disorder. Conservative therapy frequently fails, so that recurrent attacks are common. Traditional therapy often culminates in longitudinal pancreaticojejunostomy and distal pancreatectomy with Roux-en-Y pancreaticojejunostomy. We report a 9-year-old girl who had recurrent pancreatitis accompanied by multiple pancreatic cysts with stones in the pancreatic duct. She had been admitted complaining of abdominal pain. Abdominal sonography showed a dilated pancreatic duct and enlarged polycystic kidneys bilaterally. On abdominal computed tomography, there was a suspicion of a calcified shadow in a swollen pancreatic head, along with significant dilatation of the pancreatic duct in the body and the tail. With conservative treatment, the symptoms improved but relapsed 4 months later. Abdominal CT showed progressive abnormalities in the pancreas. ERCP with papillosphincterotomy was performed, resulting in the efflux of pus and stones. A stent was placed in the main pancreatic duct, which dramatically improved the patient's symptoms. We recommend endoscopic stent placement therapy in children with chronic pancreatitis with stones as an alternative to extensive surgery.