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Pediatric pancreatic hemangioma: a case report and literature review
Richard J England1, Helen Woodley, Catherine Cullinane
1Children's Liver and GI Unit, St. James's University Hospital, Leeds, United Kingdom. r.england@doctors.org.uk
Insights
Pancreatic hemangiomas are rare infant tumors causing jaundice. This case shows spontaneous regression, avoiding surgery and highlighting non-invasive management for obstructive jaundice.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Oncology
Background:
- Pancreatic hemangiomas are rare benign vascular tumors in infants.
- They can present as obstructive jaundice, mimicking other conditions.
- This case highlights an unusual presentation in a 5-month-old child.
Observation:
- A 5-month-old infant presented with obstructive jaundice, confirmed by liver function tests.
- Imaging revealed an enhancing pancreatic head mass.
- A biopsy confirmed a sclerotic hemangioma.
Findings:
- The hemangioma showed spontaneous regression over two years.
- Initial management included a cholecystostomy, followed by Roux-en-y hepaticojejunostomy for bile diversion.
- Non-surgical management led to a favorable outcome.
Implications:
- Pancreatic hemangiomas are rare and can be diagnostically challenging.
- Surgical resection should be avoided due to the potential for spontaneous involution.
- Management should focus on addressing obstructive jaundice while awaiting tumor regression.
Context:
The pancreas is an unusual site for a hemangioma in an infant. A child with obstructive jaundice caused by a pancreatic hemangioma is presented and management strategies for this benign tumor are discussed.
Case Report:
A 5-month-old girl presented with a 2-week history of jaundice, pale stools and dark urine. Liver function tests confirmed obstructive jaundice. An abdominal ultrasound scan and magnetic resonance imaging showed an enhancing mass in the head of the pancreas. At laparotomy, a wedge biopsy of the pancreatic tumor was taken and a tube cholecystostomy inserted. Histological examination of the specimen revealed a pancreatic hemangioma with sclerotic features. The high volume of bile loss from the cholecystostomy proved problematic and biliary diversion with a Roux-en-y hepaticojejunostomy was therefore performed. The tumor subsequently regressed spontaneously and was no longer visible on follow-up imaging two years later. The child has since thrived.
Conclusions:
Pancreatic hemangiomas are rare and may cause diagnostic confusion. Pancreatic resection should be avoided since the natural history of these benign tumors is that of spontaneous involution. Various strategies can be used to manage any associated obstructive jaundice.
