Pancreatic Pseudocysts In Children Research Articles

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.

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

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.

Laparoscopic cystojejunostomy as a treatment option for pancreatic pseudocysts in children—a case report

Pancreatic pseudocysts are a rare entity in children for which many approaches have been described. We report on the case of a 5-year-old boy with a pancreatic pseudocyst after blunt abdominal trauma. The patient's clinical and laboratory examination findings had also revealed an acute pancreatitis. His diagnostic workup included ultrasound examination and magnetic resonance cholangiopancreatography. Two large cysts were found at the tail of the pancreas. No injury of the pancreatic or bile duct was found. The child underwent successful laparoscopic cystojejunostomy. The patient was free of complaints after more than 2 years of follow-up. Laparoscopic cystojejunostomy in children with pancreatic pseudocysts may represent an alternative treatment option for large pancreatic pseudocysts.

Cystogastrostomy: a valid option for treating pancreatic pseudocysts of children in developing countries

Twelve children with pancreatic pseudocysts were managed for over 10 years at our institute that is a tertiary referral center of our country. A majority of them had posttraumatic pancreatic pseudocysts. Six of them were early referrals and presented within 1-2 weeks of pancreatic injury while the remaining six were referred later than 6 weeks with thick cyst walls. An initial conservative management and observation (with serial ultrasounds) led to a resolution of the pseudocysts in three patients (25% resolution rate). All the remaining subjects were treated using surgical modality (cystogastrostomy). In all the subjects where cystogastrostomy was done, the pseudocysts resolved completely, except in one child, who required the procedure to be repeated. The authors encountered no complications of the pancreatic pseudocyst disease in children i.e. infection, rupture, etc, that have been frequently described for adults. The authors conclude that pancreatic pseudocyst is a comparatively benign entity in children with a better outcome than in adults. Though various sophisticated treatment modalities are in vogue in the developed countries for managing pancreatic pseudocysts in children, cystogastrostomy is still a valid option for this purpose in the developing countries with suboptimal infrastructure and gives good results.

Pancreatic pseudocysts in children: 4 cases from Uganda.

Four cases of pancreatic pseudocyst in African children are described. There is some evidence that they followed pancreatitis of unknown aetiology. None had a history of trauma. Three were treated by cystogastrostomy, and the fourth by excision of the cyst.

Laparoscopic cystogastrostomy for the treatment of pancreatic pseudocysts in children

Pancreatic pseudocysts (PPSs) are common sequelae of pancreatitis and pancreatic trauma. The management is based upon the pseudocyst size and presence of symptoms. Those requiring intervention are often drained using several available options. The use of laparoscopic cystogastrostomy for large and recurrent PPSs has been described in adult patients as a less morbid alternative to open drainage procedures. This technique is considered a novel approach in children. We describe 2 children who had PPSs amenable to laparoscopic cystogastrostomy. The first was an 11-year-old girl who had blunt abdominal trauma from a bicycle handlebar. The second patient was a 7-year-old girl who developed idiopathic pancreatitis. Briefly, 2 ports were placed through the anterior abdominal and gastric walls, and into the lumen of the stomach. This intraluminal placement provided access to the posterior gastric wall. Using electrocautery diathermy, an incision was made through the posterior gastric wall and into the adjacent pseudocyst to obtain complete and unobstructed drainage. Both children tolerated the procedures well with resolution of their PPSs. The patients were each discharged on the fourth postoperative day and have been asymptomatic on 2 years follow-up. Laparoscopic cystogastrostomy is a safe and effective alternative to open cystogastrostomy for the minimally invasive management of PPSs in the pediatric population.

Endoscopic drainage of pancreatic pseudocysts in children

Background/Purpose Symptomatic pancreatic pseudocysts have traditionally been managed with surgical, percutaneous, and, more recently, endoscopic drainage. Although the role of the latter is well defined in the adult population, its utility in children needs to be clarified. The authors reviewed their experience with endoscopic drainage of pancreatic pseudocyst (EDPP). Methods A retrospective chart review was conducted, and relevant demographic and clinical data were obtained for all patients with pancreatic pseudocysts managed with endoscopic drainage in the period from 1997 through 2001, inclusive. Results Three children had successful endoscopic drainage of pancreatic pseudocysts. They were 9, 13, and 14 years old, and were all boys. The etiology of the pancreatitis was idiopathic related to anomalous pancreatic divisum ducts in the first 2 and azathioprine induced in the latter. The first 2 patients had endoscopic transpapillary drainage, whereas the third had an endoscopic cystduodenostomy. All patients had complete resolution of the pseudocyst clinically and radiologically after follow-up periods of 3, 31, and 21 months, respectively. The first needed a subsequent pancreaticojejunostomy for persistent symptoms related to chronic pancreatitis. A successful endoscopic drainage of a posttraumatic pancreatic pseudocyst has previously been reported from our institution. Conclusions This experience would indicate that endoscopic drainage of pancreatic pseudocyst is an effective and relatively safe option of managing this problem in children.

Endoscopic management of pancreatic pseudocyst in children

Pancreatitis is relatively rare in the pediatric population with the 3 main causes being trauma, viral infection, and drugs.1 Pancreatic pseudocyst is a well-known complication of both acute pancreatitis2 and pancreatic trauma.3-6 With conservative management, including total parenteral nutrition, spontaneous resolution is more likely in children than adults, especially when the pseudocyst is less than 5 cm in diameter. Recurrence in children is rare.7 In adults the most common cause of pseudocyst is chronic pancreatitis, whereas in children the majority are caused by blunt trauma.

Endoscopic drainage for pancreatic pseudocyst in children

The authors report here the results of endoscopic cystogastrostomy performed on 3 children aged 11, 3, and 2.5 years with nonresolving pancreatic pseudocyst (PP) of 12, 9.5, and 7 cm in diameter. The etiology of PP was abdominal trauma in 2 and idiopathic acute pancreatitis in 1 case. Ultrasound and computed tomography scans confirmed the diagnosis and suitability for gastric drainage. After the puncture of cyst, a double pig-tail stent was placed for the permanent drainage of cystogastrostomy. Complete regression was confirmed by follow-up ultrasonography at 8, 6, and 7 weeks, respectively. There were no procedure-related complications, nor was there a recurrence of cyst during the 2 years of follow-up. This report suggests that children with nonresolving PP, that are anatomically accessible, can be treated successfully and safely by endoscopic drainage. J Pediatr Surg 36:503-505. Copyright © 2001 by W.B. Saunders Company.

Successful endoscopic drainage of a posttraumatic pancreatic pseudocyst in a child

The successful endoscopic drainage of a posttraumatic pancreatic pseudocyst in a 9-year-old boy is described. This case study suggests that there is a role for endoscopic placement of stents in the treatment of pancreatic pseudocysts in children.

Management of traumatic pancreatic pseudocysts in children

Eight children with pancreatic injuries after blunt abdominal trauma are presented. One patient with pancreatitis without complications was treated successfully with medication; seven (87.5%) developed pseudocysts, which resolved spontaneously with conservative treatment in four cases (57.1%). Non-resolving pseudocysts in 3 patients finally required surgical intervention. Pseudocysts that resolve spontaneously and those that require surgical intervention can be distinguished. The two groups showed different time sequences in both serum amylase values and pseudocyst size. Analyses of these clinical data revealed three factors with significant predictive value. On the basis of these findings, a new management strategy for traumatic pancreatic pseudocysts in children is proposed. The cyst is likely to resolve spontaneously in cases showing any two or more of the following factors: (1) cyst presentation after day 6; (2) maximum serum amylase below 1,600 IU/l; and (3) serum amylase below 600 IU/l on day 20. However, early surgical intervention is required in the presence of two or more of the following: (1) cyst presentation before day 4; (2) maximum serum amylase above 1,900 IU/l; or (3) serum amylase above 1,200 IU/l on day 20.

Successful endoscopic management of pancreatic pseudocysts in children with pancreas divisum (PD)

Successful endoscopic management of pancreatic pseudocysts in children with pancreas divisum (PD)

Surgical management of the pancreatic pseudocyst in children: A long-term evaluation

Pseudocyst of the pancreas is an uncommon disorder in children. During the period of 1977 to 1990, the authors reviewed the records of 10 consecutive patients with pancreatic pseudocyst (PP) who were surgically treated in our institution. In 8 patients, the surgical procedure that was used was transgastric cystogastrostomy, and in 1 patient it was total excision of the pseudocyst. The remaining 1 patient underwent external drainage. After an average follow-up of 8.5 years, none of the patients had any complaint related to previous operation except the 1 patient who was treated with external drainage. Biochemical tests, abdominal ultrasonographies, and barium meals were also normal in 9 patients. The analysis of the results indicates that despite new percutaneous therapeutic modalities, it is still an internal drainage through transgastric cystogastrostomy that should be favored in treatment of PP in children.

The Conservative Therapy of Pancreatic Pseudocysts in Children

The Conservative Therapy of Pancreatic Pseudocysts in Children

Treatment of traumatic pancreatic pseudocysts in children: The role of percutaneous catheter drainage : M. Hendrickson, M.E. Matlak, R.B. Jaffe, et al. Pediatr Surg Int 5:347–349, (August), 1990

Treatment of traumatic pancreatic pseudocysts in children: The role of percutaneous catheter drainage : M. Hendrickson, M.E. Matlak, R.B. Jaffe, et al. Pediatr Surg Int 5:347–349, (August), 1990

Pancreatic Pseudocyst

A pseudocyst of the pancreas in a 6-year-old girl persisted for 2 months despite bowel rest and nutritional support. Following percutaneous introduction of a catheter into the cyst under ultrasound guidance and external catheter drainage for 11 days, the pseudocyst resolved completely and permanently. Nonoperative percutaneous techniques for drainage of pancreatic pseudocysts in children may be an effective alternative to surgical intervention.

Pancreatic Pseudocyst

SummaryA pseudocyst of the pancreas in a 6‐year‐old girl persisted for 2 months despite bowel rest and nutritional support. Following percutaneous introduction of a catheter into the cyst under ultrasound guidance and external catheter drainage for 11 days, the pseudocyst resolved completely and permanently. Nonoperative percutaneous techniques for drainage of pancreatic pseudocysts in children may be an effective alternative to surgical intervention.

Percutaneous Drainage of Traumatic Pancreatic Pseudocysts in Children

To determine the effectiveness of percutaneous drainage of traumatic pancreatic pseudocysts, we reviewed the courses of 13 children. Six pseudocysts resolved on complete bowel rest and total parenteral nutrition. Seven required further therapy. Two pseudocysts were treated operatively; five were drained percutaneously with fluoroscopic guidance. These five ranged from 5 to 15 cm in diameter and were present for 10 to 42 days (mean, 26 days). In all cases, the cyst fluid was clear, had an amylase level of greater than 40,000 IU/L, and grew no organisms. The pigtail catheters left in place in four of the five children were removed when drainage stopped. Patients were followed by ultrasound while still in the hospital and 1 month after discharge. There were no complications nor any pseudocyst recurrence. Percutaneous drainage of traumatic pancreatic pseudocysts in children is an effective alternative to the standard operative therapy of pseudocystenteric anastomosis.

Failure of percutaneous drainage in children with traumatic pancreatic pseudocysts

Recent reports have documented the successful use of percutaneous drainage (PD) in the management of traumatic pancreatic pseudocysts in children. This study presents four cases of pancreatic pseudocyst in which percutaneous catheter drainage was performed. In one instance, no operative therapy was required. However, in the other three cases PD failed to resolve the problem and distal pancreatectomy with splenic salvage was performed when contrast studies (endoscopic retrograde cholangiopancreatography or catheter injection) demonstrated disruption of the main pancreatic duct. This report suggests that children with pancreatic pseudocysts unresponsive to PD require prompt investigation of ductal anatomy to rule out transection or other major injury.

Treatment of traumatic pancreatic pseudocysts in children: the role of percutaneous catheter drainage

Six cases of successful percutaneous catheter drainage (PCD) of pancreatic pseudocysts in children ages 3–13 years are presented. All cases involved blunt abdominal trauma and presented with abdominal pain, vomiting, epigastric tenderness without a palpable mass, and elevated serum amylase. Indications for PCD were an enlarging pseudocysts and marked abdominal pain. Catheter placement was accomplished using CT guidance 15.3±1.8 days (mean ± SEM) following injury. Two patients had transgastric PCD. None of the pseudocysts were infected. Catheters were left in place until the drainage ceased, the serum amylase approached normal, the pseudocyst resolved on ultrasound, and the asymptomatic patient tolerated enteral feedings with the catheter clamped. The mean duration of catheter drainage was 18.3±3.7 days. At the time of catheter insertion, the range of serum amylase values was 242–2810 IU/l, while discharge values were 50–147 IU/l (normal: 16–108 IU/l). The mean hospital stay was 36.2±3.8 days and the mean length of total parenteral nutrition was 27.5±4.5 days. All pseudocysts were treated successfully without complication. PCD of traumatic pancreatic pseudocysts in children was performed safely and effectively in our study. Use of this therapeutic modality allowed earlier treatment, decreased the duration of symptoms, and avoided abdominal operation. PCD may prove to be the treatment of choice for pancreatic pseudocysts in children.