Pancreatic Pseudocysts In Children Research Articles

Pancreatic pseudocyst in children

Pancreatic injuries include a variety of injuries from simple contusion to complete rupture of the duct and pancreatic head. Although pancreatic lesions are rare in children, the pancreatic pseudocyst is the most common posttraumatic cystic lesion of the pancreas and is a localized collection containing pancreatic juice and the peripancreatic necrotic test. The management of the pancreatic pseudocyst has evolved from the stage of exclusive surgical treatment exclusively, to the conservative one, respectively the stage of minimally invasive treatment (percutaneous drainage, endoscopic drainage) and laparoscopic treatment. However, the management remains controversial, the approach depending on the type of lesion, size and evolutionary characteristics. This paper presents the case of a pediatric patient, polytrauma due to a rail accident who is diagnosed 3 weeks after hospitalization with a pseudocyst of the pancreas. We will present both he diagnostic means and the management, both medicinal and surgical, as well as the subsequent evolution of the patient.

Laparoscopic Cystogastrostomy in Children with Pancreatic Pseudocysts: A Preliminary Experience of Eight Cases.

Introduction:Pancreatic pseudocysts (PPCs) and walled-off necrosis (WON) in children following acute pancreatitis are uncommon. The various modalities of therapy possible are conservative treatment, external drainage, endoscopic stenting, and internal surgical drainage procedures. There are no existing guidelines for the management of PPC in children. We evaluate the outcomes of laparoscopic cystogastrostomy (LCG) performed at our center.Materials and Methods:Eight children (median age: 10 years) underwent LCG for large PPC (median size: 12.5 cm). There were seven patients with PPC and one with WON. Seven underwent LCG by a transgastric approach and one underwent LCG by a retrogastric approach.Results:Seven out of the eight patients had complete resolution of symptoms and the PPC. The median follow-up period was 32 months (interquartile range: 9.5–55.5 months). There were no conversions. There was one patient with a WON who developed a recurrence.Conclusion:LCG is a safe and effective treatment option for large PPC/WON in children. A posterior retrogastric approach, when indicated, is a safe approach with a comparable outcome.

English

It is difficult to diagnose pancreatic cysts in children. Any previous history of acute pancreatitis is very important because it can lead to a wide set of complications like pseudocyst, pancreatic necrosis, splenic venous thrombosis etc. The most known and common cause of pancreatic pseudocyst in children is trauma. The characteristic features of pancreatitis include abdominal pain, serum lipase or amylase values three times more than that of the normal range and characteristic radiological features. Pancreatic pseudocyst may occur in 15 % of children with acute pancreatitis as a complication.1 Pancreatic juice collection enclosed by a wall of granulation or fibrous tissue, is defined as a pseudocyst. As the resulting cyst has no true endothelial lining, it is classified as a pseudocyst.2 The pseudocyst contains inflammatory pancreatic fluid, mainly the lipase enzyme or semisolid matter. The incidence of pseudocyst is relatively low 1.6 % - 4.5 %, or 0.5 - 1 per 100 000 adults per year.2 Very few cases of pancreatic pseudocyst have been reported in world literature. Commonly, it develops as a sequel of acute or chronic pancreatitis. It develops around 4 weeks after the episode of acute pancreatitis.3 It is characterized by pancreatic inflammation, abdominal pain and raised levels of serum digestive enzymes.4 Here we discuss a case report of pancreatic pseudocyst in a 10-year-old male child presenting with history of abdominal pain and decreased appetite.

Open cystogastrostomy in the management of a large pancreatic pseudocyst in a child

Abstract Pancreatic pseudocyst is the most common cystic lesion of the pancreas. Unlike in adults, where gall stones and alcohol are the most common etiology, trauma is the leading cause of pancreatic pseudocyst in children. Most pancreatic pseudocysts in children resolve spontaneously with conservative management. Lesions that are symptomatic, larger than 6 cm in diameter, or persist for 6 weeks or more following the initial insult, usually require some sort of therapeutic intervention. Therapeutic interventions vary depending on the cyst's nature and position, presence of complications and surgeon's experience. These include percutaneous drainage, endoscopic drainage and surgical drainage by laparotomy or recently by laparoscopy. We present a nine years old male child with large pancreatic pseudocyst following blunt abdominal trauma. We discuss the mode of presentation, diagnostic evaluation and therapeutic intervention that has been done to treat him.

Mediastinal pancreatic pseudocyst in children: A case report and review of literature

Mediastinal pancreatic pseudocyst (MPP) is an infrequent complication of acute pancreatitis in children. A contrast-enhanced computed tomogram (CECT) of the chest and abdomen can aid in diagnosing pleural effusion and MPP. We describe a child with MPP in whom a transcutaneous computed tomogram-guided external drainage was curative. The case is being presented, and the relevant literature is highlighted in view of rarity of this entity.

Management of pancreatic pseudocysts in pediatric oncology patients

BackgroundManagement of children with pancreatic pseudocysts has historically been adopted from the adult experience where pancreatic pseudocysts greater than 6 cm are unlikely to resolve without intervention. We reviewed the clinical course of pediatric oncology patients with pancreatic pseudocysts. MethodsA retrospective review of patients treated over a 15-year period was performed. Variables evaluated included cancer type, medications administered, clinical and imaging characteristics of the pancreatic pseudocysts, treatment and outcome. ResultsA total of 132 patients with a median age of 13 (IQR, 9–17) years were identified with pancreatitis. Thirty-one (23.5%) patients developed a pancreatic pseudocyst, of which 84% were associated with PEG-asparaginase treatment. The median pseudocyst size was 7.6 (IQR, 4.4–9.9) cm with 59% being greater than 6 cm. Twenty-two (71%) patients with a pancreatic pseudocyst underwent successful conservative management, while only 9 (29%) required procedural intervention including six percutaneous drainage, one of whom recurred and required surgical cyst-enteric drainage. Two other patients had primary surgical cyst-enteric drainage and one patient underwent endoscopic retrograde cholangiopancreatography with stenting. The indication for intervention was worsening pain rather than pseudocyst imaging characteristics, size or serum amylase/lipase. ConclusionMost medication-induced pancreatic pseudocysts in children being treated for cancer, regardless of pseudocyst size, can be managed non-operatively or with transgastric percutaneous drainage. The need for intervention can be safely dictated by patient symptoms. Level of evidenceIII

Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion

BackgroundEndoscopic ultrasound is seldom available at paediatric centres; therefore drainage of pancreatic pseudocysts in children has traditionally been achieved by surgery.ObjectiveThis study assessed the feasibility and safety of performing image-guided internal drainage of pancreatic pseudocysts with a flanged self-expanding covered nitinol pancreatic pseudocyst drainage stent.Materials and methodsWe conducted a retrospective case note review of children undergoing image-guided cystogastrostomy at two paediatric hospitals. Percutaneous access to the stomach was achieved via an existing gastrostomy tract or image-guided formation of a new tract. Under combined ultrasound, fluoroscopic or cone-beam CT guidance the pancreatic pseudocysts were punctured through the posterior wall of the stomach. A self-expanding covered nitinol stent was deployed to create a cystogastrostomy opening.ResultsImage-guided cystogastrostomy was performed in 6 children (4 male; median age 6 years, range 46 months to 15 years; median weight 18 kg, range 13.8–47 kg). Two children had prior failed attempts at surgical or endoscopic drainage. Median maximum cyst diameter was 11.5 cm (range 4.7–15.5 cm) pre-procedure. Technical success was 100%. There were no complications. There was complete pseudocyst resolution in five children and a small (2.1-cm) residual pseudocyst in one. Pseudocyst-related symptoms resolved in all children.ConclusionPancreatic pseudocyst drainage can be successfully performed in children by image-guided placement of a cystogastrostomy stent. In this cohort of six children there were no complications.

Diagnosis and treatment of 50 children with pancreatic pseudocysts

Objective To study the clinical features, diagnosis and treatment of pancreatic pseudocysts in children. Methods A retrospective study was conducted on 50 children with pancreatic pseudocysts diagnosed and treated in the Children's Hospital of Chongqing Medical University from September 2006 to August 2017. 36 of these 50 children were treated with external drainage (including 2 patients after conservative treatment), 5 internal drainage (including 2 patients after external drainage), and 13 conservative treatment. Results 47 patients were diagnosed by clinical symptoms, amylase examinations, ultrasound and CT scans; and 3 patients by surgical exploration. Of the 36 patients who were treated with external drainage, 29 recovered and 5 improved. Two patients relapsed and underwent internal drainage. Five patients who were treated with internal drainage recovered. Of 13 patients who were treated with conservation treatment, 10 were cured, 1 recovered well, and the remaining 2 developed relapse and underwent external drainage. Conclusions The incidence of pancreatic pseudocyst in children was low. The diagnosis depended on clinical symptoms, biochemical and radiological examinations. For patients with small cysts, no complications and asymptomatic, conservative treatment is suggested. There were no obvious differences in the treatment results between internal and external drainage, and external drainage is advocated because of its advantages. Differences in the etiology play a vital role in the choice of treatment. In elective surgery for a pancreatic pseudocyst caused by trauma, external drainage is preferred. For those who developed after pancreatitis, internal drainage is advocated. Key words: Pancreatic pseudocysts, children; Diagnosis; Therapy

Pancreatic pseudocyst in children: a rare medical entity

Pancreatic pseudocyst (PCC) is an extremely rare medical condition in pediatric population. The history of acute pancreatitis holds significance as it may progress into formation of such pseudo cyst in children. Acute pancreatitis may result from abdominal injury, biliary tract disease, viral illness, states of intracranial hypertension and steroids. However blunt abdominal trauma is the most common cause of pancreatic pseudocysts in children. Here we report a case of blunt abdominal trauma in a six-year-old child that resulted in pancreatic pseudocyst which was treated effectively with cystogastrostomy.

Mo1440 The Pure Endoscopic Drainage of Pancreatic Pseudocysts in Children - a Safe and Eficient Method - Case Series

Mo1440 The Pure Endoscopic Drainage of Pancreatic Pseudocysts in Children - a Safe and Eficient Method - Case Series

Pancreatic pseudocyst in children

Background and objectives: Pancreatic pseudocysts are rare in children, with most series describing not more than 24 patients. At Zagazig University Hospital we have managed a range of cases of this disorder and feel this experience should add to the existing experience with children. This study aimed to analyze the causes, clinical presentation, and management of symptomatic pancreatic pseudocysts treated at our institution. Patients and methods: This study included 19 children. Their ages ranged from 1 month to 17 years. All cases were diagnosed as pancreatic pseudocysts and were admitted and treated in the Pediatric Surgery Unit, Zagazig University Hospital, during the period from 1996 to 2011. The collected data included age, sex, etiology, clinical presentation, radiological information, operative data, postoperative complications, and the final outcome. Results: Twelve patients (63.2%) had a history of abdominal trauma, whereas the remaining seven patients (36.8%) had no abdominal trauma. The pseudocysts were acute in 11 patients, chronic in seven patients, and only one patient had congenital pseudocyst. Nine patients improved with expectant treatment; however, 10 patients required surgery. The surgical intervention included cystogastrostomy for four patients, cystojejunostomy for two patients, complete excision with distal pancreatectomy in two children, and partial excision with external drainage in the remaining two patients. One patient developed postoperative wound infection, and two cases had external pancreatic fistula. Conclusion: Although spontaneous resolution of pancreatic pseudocysts occurred, more commonly, in acute, small-sized, and post-traumatic cysts, the surgical treatment of pancreatic pseudocyst is a valid, safe, effective, and satisfactory treatment, especially in complicated cases. Keywords: children, drainage, conservative treatment, pancreatic pseudocyst, pancreatitis, surgical treatment

Non-operative treatment versus percutaneous drainage of pancreatic pseudocysts in children

The objective of this study was to characterize the clinical course and outcomes of children with pancreatic pseudocysts that were initially treated non-operatively or with percutaneous drainage. A retrospective review of children with pancreatic pseudocysts over a 12-year period was completed. Categorical variables were compared using Fischer's exact method and the Student's t test was used to compare continuous variables. Analysis was done using logistic and linear regression models. Thirty-six children met the criteria for pancreatic pseudocyst and 33 children were treated either non-operatively or with percutaneous drainage. Of the 22 children managed non-operatively, 17 required no additional intervention (77 %) and five required surgery. Operative procedures were: Frey procedure (3), distal pancreatectomy (1), and cystgastrostomy (1). Eight of the 11 children treated with initial percutaneous drainage required no additional treatment (72 %). The other three children underwent distal pancreatectomy. Success of non-operative management or percutaneous drainage was not dependent on size or complexity of the pseudocyst Logistic regression did not identify any patient demographic (gender, age, and weight), etiologic (trauma, non-traumatic pancreatitis) or pseudocyst characteristic (size, septations) that predicted failure of non-operative therapy. In children, pancreatic pseudocysts can frequently be managed without surgery regardless of size or complexity of the pseudocyst. When an intervention is needed, percutaneous drainage can be performed successfully, avoiding the need for major surgical intervention in the majority of patients.

Pancreatic Pseudocysts in Children

The aim of the present study was to review the use of endoscopic cyst gastrostomy (E-CG) as a treatment option for pancreatic pseudocysts referred to a tertiary paediatric surgical centre. Retrospective review during a 10-year period (January 2001-December 2010). Cyst gastrostomies were performed using 1 or 2 double pigtailed Zimmon stents (7-10 Fr) under general anaesthesia. Data are quoted as median (range). E-CG was performed in 7 (5 males) children (median age at presentation 11.7 [8.2-15.8] years). Pancreatic pseudocysts were caused by acute pancreatitis in 5 (gallstones n = 1, hereditary pancreatitis n = 1, pancreatic divisum n = 1, asparaginase induced n = 1, and idiopathic n = 1) and pancreatic trauma in 2 (motor vehicle accident n = 1, and handlebar injury n = 1). All of the cases were associated with a rise in serum amylase level, median 1028 (276-2077) IU/L at the peak of symptoms. Three children had pancreatic duct stent placement during endoscopic retrograde cholangiopancreatography as the initial therapeutic intervention, but went on to have E-CG later. One who had a huge pseudocyst at presentation had already undergone an open cyst gastrostomy, which had recurred at 1 month. Rescue E-CG was performed 38 days later. All of the stents were removed endoscopically at 8 (6-40) weeks. E-CG was uncomplicated and pseudocysts resolved completely in 5. One required repeat placement at 15 days due to catheter slippage with later full resolution. One child required open cyst gastrostomy due to reaccumulation two months following removal of the stent. Median hospital stay post E-CG was 3 (1-23) days. There has been no recurrence at median follow-up of 18 (5-108) months. Endoscopic cyst gastrostomy is a safe and effective alternative for the management of pancreatic pseudocysts in children and should now be considered as treatment of choice.

Somatostatine analogue in nonoperative treatment of posttraumatic pancreatic pseudocyst in a child: a case report

Abstract Pancreatic pseudocyst is a complication of pancreatic trauma. We describe improved nonoperative treatment of patient with posttraumatic pancreatic pseudocyst with somatostatin analogue. A 9-year-old girl was admitted to our hospital after blunt abdominal trauma with handlebar. Three weeks after abdominal trauma, pancreatic pseudocyst developed. Nonoperative treatment of posttraumatic pancreatic pseudocyst (the largest dimensions 70 × 55 × 65 mm) with somatostatin analogue, octreotide acetate, was applied for the next 52 days. The patient was followed up for 24 months after the discontinuation of octreotide and there were no recurrence of pancreatic pseudocyst. Somatostatin analogue could be usefull in the nonoperative treatment of posttraumatic pancreatic pseudocysts in children.

Resolution of a Posttraumatic Pancreatic Pseudocyst with Octreotide Acetate in a Pediatric Patient

A pancreatic pseudocyst is a complication of abdominal trauma in pediatric patients. Octreotide acetate is an effective adjunct therapy used in combination with traditional surgical approaches. We describe a 19-month-old boy with a pancreatic pseudocyst secondary to blunt abdominal trauma who was successfully managed with octreotide acetate in combination with percutaneous drainage and the placement of a pancreatic stent. Octreotide acetate 1 μg/kg/hour was administered as a continuous intravenous infusion for 24 hours, followed by 2.5 μg/kg/dose every 12 hours subcutaneously for 11 days. The patient was discharged after the pseudocyst had resolved and oral feeding was restored. He had no recurrence of the pseudocyst. The published literature regarding octreotide acetate therapy for pediatric pancreatic pseudocysts is limited. Previously reported cases demonstrated successful resolution of pancreatic pseudocysts with varying doses of intravenous and subcutaneous octreotide acetate within 23-30 days; however, with our patient's regimen, along with surgical interventions, the pseudocyst resolved within 11 days. In addition, our patient's regimen involved higher doses of octreotide acetate given more frequently than those reported in the literature. This case report illustrates that use of higher octreotide acetate dosages may be a potential adjunct therapy to surgical interventions for the management of pancreatic pseudocysts in children.

Conservative Management of Pancreatic Pseudocysts in Children With Acute Lymphoblastic Leukemia

Treatment with asparaginase for acute lymphoblastic leukemia can cause acute pancreatitis. Complication of pancreatitis by pancreatic pseudocyst formation can prolong the hospital stay, delay chemotherapy, and necessitate long-term parenteral nutrition. We report 5 children with acute lymphoblastic leukemia who developed acute pancreatitis complicated by pancreatic pseudocysts. They required modifications to their chemotherapy regimen and prolonged parenteral nutrition but no surgical intervention. All 5 patients survive in first remission and their pseudocysts resolved after 3 to 37 months or continued to decrease in size at last follow-up. These cases illustrate that nonsurgical management of pancreatic pseudocyst is safe, though pseudocyst resolution may require many months. In addition, these patients demonstrate that oral feeding can be initiated after the acute episode of pancreatitis resolves even if a pseudocyst is present.

Laparoscopic Treatment of Pancreatic Pseudocysts in Children

Pancreatic pseudocysts are problematic sequelae of pancreatitis or pancreatic trauma causing persistent abdominal pain, nausea, and gastric outlet obstruction. Due to the low volume of disease in children, there is scant information in the literature on the operative management of pseudocysts with minimally invasive techniques. We conducted a multi-institutional review to illustrate several technical variations utilized in achieving laparoscopic cystgastrostomy in the pediatric population. A retrospective review was conducted of all patients who underwent laparoscopic cystgastrostomy in five institutions. Patient data, operative techniques, and postoperative course were analyzed. There were 13 patients with a mean age of 10.4 years and mean weight of 52.1 kg. The etiologies of pancreatitis included: trauma (4), gallstones (3), chemotherapy (2), hereditary (1), and idiopathic (3). Preoperative radiographic measurements of the maximal cyst diameter averaged 11.7 cm. Cystgastrostomy was approached by using transgastric exposure in 5 cases and intragastric ports in 8 cases. An average of four ports were used to complete these operations. Mean operative time was 113 minutes. There were no conversions in this series. Cystgastrostomy was performed by using an endoscopic stapler (average 3.8 loads) in 6 cases, sutures in 6 cases, and 1 was formed solely with the Harmonic Scalpel (Johnson and Johnson). Gastrotomy sites were closed by using a stapler in 4 cases and suture techniques in 9. Mean time to initial and goal feeds was 3 and 4 days, respectively. Postoperative imaging revealed persistent pseudocyst in 1 patient, who was treated with a distal pancreatectomy. Therefore, 92% required no further operative intervention and remained asymptomatic upon recovery from their pancreatitis. A laparoscopic approach to pancreatic cystgastrostomy for chronic pseudocyst proved to be safe and effective in this five-institution survey. Techniques varied, but 92% had complete resolution with minimal morbidity and rapid recovery. Laparoscopic cystgastrostomy should be considered as an appropriate first-line treatment for chronic pseudocysts in children.

Therapeutic Success of Endoscopic Ultrasound-Guided Drainage of Pancreatic Pseudocysts in a Pediatric Population

Background: Endoscopic drainage has become established as the primary therapy for pancreatic pseudocysts (PC) in adults. Endoscopic ultrasound (EUS) has improved the safety and efficacy of transmural drainage by identification of blood vessels, wall thickness and most optimal site for cyst puncture. However, the management of symptomatic PC among children is less clear regarding the role of EUS. Aim: The aim of this study was to evaluate the success and safety of linear EUS-guided drainage of symptomatic pancreatic PC in children. Methods: Children who presented to our institution between 1/2004 and 8/2008 with symptomatic PC were included. All patients had pancreatic cysts noted on CT imaging. EUS was performed with the curvilinear array Olympus endoscope (GFUC140-P or GFUCT140) and either 19- or 22-guage Cook aspiration needles. Antibiotic prophylaxis was administered prior to endoscopy. PC was confirmed by the appearance on CT and/or EUS, fluid aspiration with histology and in certain cases elevated fluid amylase and low fluid CEA levels. Complete aspiration of smaller cysts was attempted. In other cysts, one to two 10 Fr double pig-tailed plastic stents were placed for 8 weeks and removed after resolution of the PC. Results: The group included 9 patients age <18years (4-17years), (6 females, 3 males). Etiologies of pancreatitis and PC included biliary stones (2), trauma (2), idiopathic (3), familial (1), and divisum (1). Indications for therapy included fever (2), pain (5) and impaired oral intake (2). In the initial cases, EUS served as a salvage therapy for failed ERCP (2), then a combined modality (2), and finally the primary modality to treat pancreatic cysts (5). Cysts larger than 5 cm required EUS-guided cyst-gastrostomy with placement of transmural stents while smaller cysts could be successfully aspirated alone. One patient (familial pancreatitis) had initial success with cyst drainage but developed a second PC during recurrent pancreatitis 8 months later which necessitated surgical intervention for hemosuccus pancreaticus. The remaining 8 patients (89%) had complete resolution of symptoms without recurrence. In 3 of 9 patients, infected cysts were present and were treated successfully with EUS-guided transmural stent placement. Conclusions: EUS drainage of pancreatic PC is safe with durable symptom relief in a pediatric population. Cysts smaller than 5cm can be aspirated successfully without stent placement. Infected cysts can be managed effectively with transmural stents. This series demonstrates that the need for ERCP has diminished over time as the use of EUS-guided PC drainage has evolved into the primary modality.

Endoscopic management of pancreatic pseudocyst in children—a long-term follow-up

Background Literature on long-term outcome after endoscopic management of pediatric pancreatic pseudocyst is not available. The aim of the present study is to report long-term outcome after endoscopic drainage of pancreatic pseudocyst in children. Methods Nine patients younger than 15 years, subjected to endoscopic pseudocyst drainage, were included in this study (between 1994 and 2004). Eight patients were subjected to endoscopic cystogastrostomy and stenting, whereas 1 patient was subjected to cystoduodenostomy and stenting. A follow-up of patients was done at 1 month and at 2 to 10 years after drainage. Endoscopic retrograde cholangiopancreatography (ERCP) was done in 2 patients at the time of drainage, and it was repeated in both the patients at the time of final follow-up. Results Mean age of the patients was 9.6 years. Trauma was the most common cause (n = 8). Mean follow-up of these patients was 5.7 years (2-10 years). No recurrence was seen in any patient. Endoscopic retrograde cholangiopancreatography revealed complete pancreatic duct block in prevertebral region in 2 posttraumatic patients, and it was persisting on repeat ERCP at final follow-up. Conclusions Endoscopic drainage of pancreatic pseudocyst is safe in children with a very good long-term outcome. Pancreatic duct block seen on ERCP may not be clinically important on long-term follow-up.

Laparoscopic Intragastric Stapled Cystgastrostomy of Pancreatic Pseudocyst in a Child

The current management for pancreatic pseudocysts in children is predicated on adult techniques and includes open, endoscopic, percutaneous, and laparoscopic drainage. In this paper, we report our technique using two intragastric cannulas for the creation of a laparoscopic stapled pancreatic cystgastrostomy.