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Pancreas pseudocyst associated with L-asparaginase treatment: a case report

R Karabulut1, K Sönmez, C Afşarlar

  • 1Department of Paediatric Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey. karabulutr@yahoo.com

Acta Chirurgica Belgica
|January 28, 2006
PubMed

Insights

L-asparaginase, a common pediatric cancer treatment, can cause pancreatitis. This case highlights successful non-invasive treatment of a rare pancreatic pseudocyst complication in a child with acute lymphoblastic leukemia (ALL).

Area of Science:

  • Pediatric Oncology
  • Gastroenterology
  • Medical Complications

Background:

  • L-asparaginase is a critical chemotherapeutic agent for pediatric malignancies, particularly acute lymphoblastic leukemia (ALL).
  • Pancreatitis is a known complication of L-asparaginase therapy, occurring in 2%-16% of pediatric patients.
  • Pancreatic pseudocysts are a rare but serious complication, with only seven pediatric cases previously reported.

Observation:

  • A 5-year-old girl diagnosed with ALL developed abdominal pain and epigastric dullness after her third course of the BMF-95 protocol.
  • Abdominal tomography revealed a large pancreatic pseudocyst measuring 10 x 10 cm.
  • The patient presented with symptoms indicative of a significant intra-abdominal complication.

Findings:

  • The pancreatic pseudocyst was successfully managed non-invasively using percutaneous external drainage.
  • Treatment also included total parenteral nutrition (TPN), octreotide administration, and a one-month course of antibiotherapy.
  • Percutaneous drainage proved effective and safe, avoiding high-risk surgical intervention in this medically complex pediatric patient.

Implications:

  • This case demonstrates the efficacy of percutaneous external drainage for pancreatic pseudocysts in pediatric oncology patients.
  • Non-invasive management strategies are crucial for patients with systemic disorders and high surgical risks.
  • Further research into L-asparaginase-induced pancreatic complications and their optimal management is warranted.

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