PANCREATITIS FOLLOWING ERCP MANAGEMENT OF CHILDHOOD CHOLEDOCHAL CYST

Abstract

35 Pancreatitis is not uncommon in children with congenital choledochal cysts. In many, the pancreatitis is thought to be caused by anomalous proximal insertion of the main pancreatic duct into the common bile duct. In this situation, it is thought that there is to-and-fro flux of pancreatic and biliary fluids with resultant pancreatitis and common bile duct injury. We began care of two girls (aged 5 and 12 yrs) who were previously diagnosed as having Caroli's disease and had undergone repeated ERCP procedures with placement of biliary stents. Our evaluation indicated that both patients had choledochal cysts. They were managed with routine choledochal cyst excision, and roux-en-y hepaticojejunostomy. None of our other previous patients undergoing this standard care for choledochal cyst had problematic postoperative pancreatitis. However, both of these patients had significant and repetitive bouts of post-operative pancreatitis. Associated with this was the presence of severe proximal scarring of the main proximal pancreatic duct and dilatation of the distal pancreatic duct. Short-term management was successful by sphincterotomy and stenting. However, both patients eventually underwent Puestow procedures and are now doing well. CONCLUSION: Long-term management of congenital choledochal cysts with ERCP is probably ill-advised and could result in complications due to chronic pancreatitis and pancreatic duct stricture.