Endoscopic ultrasound-guided cystogastrostomy in the treatment of the complicated form of acute pancreatitis in children

Abstract

Acute pancreatitis is relatively rare in children, with approximately 313 cases per 100,000 populations annually, and complicated forms are three times less common than those in adults. However, recently, the number of acute pancreatitis cases in children has increased, which entails a relatively higher incidence of complicated acute pancreatitis, including parapancreatic acute fluid accumulation, and determines the relevance of this problem for pediatric surgeons.
 In this study, using two sample observations, parapancreatic pseudocyst puncture under ultrasound and X-ray control was presented, a conductor string was introduced into the cavity of the pseudocyst, and further stenting of this anastomosis was performed with two plastic double-pigtail stents. In the first case, a 12-year-old boy underwent surgery for idiopathic pancreatitis and acute parapancreatic fluid accumulation in the pancreatic tail. In the second case, a 10-year-old girl presented with a parapancreatic pseudocyst, which was caused by drug-induced pancreatitis (a complication of the long-term use of valproic acid, an antiepileptic drug). Both children underwent surgery using this technique. Antisecretory therapy was performed postoperatively. In the catamnesis after 1 year and 6 months, the children had no complaints, and ultrasound and X-ray studies did not reveal any pathology. Endoscopic cystogastrostomy under ultrasound guidance is widely performed in complicated pancreatitis in adults. These observations show its effectiveness in pediatric practice. However, the relatively short observation period of treatment results requires additional research on a much larger number of cases and outcomes of these surgical interventions in children.