Pancreatitis and Pancreatic Pseudocyst in Children

Fig. 43.1
Abdominal CT scan showing posttraumatic pancreatic pseudocyst in a child. Note its relation to the pancreas and stomach
  • Abdominal magnetic resonance imaging (MRI).
  • Endoscopic retrograde cholangiopancreatography (ERCP) is useful for the diagnosis of various ductal abnormalities or obstructions and may serve as a therapeutic intervention (i.e., sphincterotomy, stone extraction, stent placement).
  • Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive alternative to ERCP but lacks therapeutic capabilities.

      Medical Management

      • Adequate rehydration.
      • Analgesia.
      • Pancreatic rest.
      • Antacids or H2-histamine blockers are useful to prevent gastritis and reduce duodenal acid exposure.
      • In severe pancreatitis, oral intake is restricted and parental nutrition is started within 3 days to prevent catabolism.
      • In cases of intractable vomiting or ileus, nasogastric suction is beneficial to prevent vomiting, manage ileus, and provide pancreatic rest.
      • Antibiotic therapy is indicated for systemic infections or sepsis.

      Surgical Management

      • Surgical intervention is indicated for:
        • The management of congenital anatomic defects (e.g., pancreatic divisum).
        • The management of complications associated with acute pancreatitis :
          • ◦ Pancreatic ascites
          • ◦Intra-abdominal abscess
          • ◦Pancreatic pseudocyst
        • Acute pancreatic pseudocysts are managed with observation for 4–6 weeks because most resolve spontaneously.
        • Chronic pancreatic pseudocysts (> 3 mo) are best treated by surgical interventions such as:
          • ◦ Ultrasonography-guided or CT-guided percutaneous drainage
          • ◦ Endoscopic drainage
          • ◦ Internal drainage via cyst gastrostomy or enterostomy
      • Surgery for pancreatic ductal disruption or compromise (i.e., acute traumatic pancreatitis with ductal injury) is indicated after medical failure.
      • ERCP or intraoperative pancreatic ductography is valuable in determining the site of ductal disruption and directs surgical decision making to the most appropriate operative procedure.
      • Operative management of chronic pancreatitis in children is controversial.
      • Indications for operative intervention include:
        • ◦ Unsuccessful conservative medical therapy
        • ◦ Intractable pain
        • ◦ Impaired nutrition
      • Surgical options include:
        • ◦ Distal pancreatectomy with Roux-en-Y pancreaticojejunostomy (Duval procedure)
        • ◦ Lateral pancreaticojejunostomy (Puestow procedure)
        • ◦ ERCP sphincteroplasty
        • ◦ Total pancreatectomy and islet cell transplantation

      Pancreatic Pseudocyst

      • Pancreatic pseudocysts are often caused by:
        • Acute or chronic pancreatitis
        • Abdominal trauma
        • Alcohol-induced pancreatitis
      • Pseudocysts are more often present in chronic pancreatitis patients than in acute pancreatitis patients.

      Clinical Features

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      Mar 8, 2017 | Posted by in PEDIATRICS | Comments Off on Pancreatitis and Pancreatic Pseudocyst in Children

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