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Laparoscopic pancreatic necrosectomy in a child with severe acute pancreatitis
Juan-Carlos Pattillo1, Ricardo Funke
1Sección Cirugía Pediátrica, División de Cirugía, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile. jpattill@med.puc.cl
Insights
This case study details a 12-year-old boy with severe acute pancreatitis (AP) successfully treated with laparoscopic pancreatic necrosectomy. The report highlights the first pediatric use of this minimally invasive technique for severe AP management.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Minimally Invasive Surgery
Background:
- Severe acute pancreatitis (AP) in children is uncommon but can lead to significant morbidity.
- Pediatric AP management often relies on conservative measures, with surgical intervention reserved for refractory cases.
- Laparoscopic approaches for pediatric AP are not well-established.
Observation:
- A 12-year-old boy presented with severe AP requiring repeated laparoscopic pancreatic necrosectomy.
- Post-necrosectomy, he developed a pancreatic pseudocyst treated endoscopically.
- Subsequent investigations revealed missed common bile duct (CBD) stones, necessitating further intervention.
Findings:
- The patient underwent successful laparoscopic pancreatic necrosectomy, a novel approach in pediatric AP.
- Endoscopic management of the pseudocyst was performed.
- Laparoscopic cholecystectomy with CBD exploration successfully addressed the overlooked choledocholithiasis.
Implications:
- Laparoscopic pancreatic necrosectomy may be a viable option for severe pediatric AP, offering a minimally invasive alternative.
- This case underscores the importance of thorough imaging to detect biliary pathology in pediatric AP.
- Successful multi-stage laparoscopic and endoscopic management offers a comprehensive treatment strategy for complex pediatric AP.
Abstract:
Acute pancreatitis (AP) in children usually follows a mild course but occasionally may be severally problematic. We report the case of a 12-year-old boy with severe AP who was managed with repeated laparoscopic pancreatic necrosectomy. Three weeks later he represented with a pancreatic pseudocyst that was treated with endoscopic gastrocystotomy. His abdominal pain persisted and a subsequent magnetic resonance cholangiopancreatogram showed multiple gallbladder and common bile duct (CBD) stones that were missed on previous imaging investigations. He underwent laparoscopic cholecystectomy with transcystic exploration of the CBD. The patient is currently well, more than 2 years following the definitive corrective surgery. To the best of our knowledge, this is the first case of laparoscopic pancreatic necrosectomy in a child.