Related Experiment Videos
Percutaneous transgastric drainage of the lesser sac in children
G M Amundson1, R B Towbin, D L Mueller
1Department for Diagnostic Imaging, Alberta Children's Hospital, Calgary, Canada.
Insights
Percutaneous transgastric drainage successfully treated lesser sac fluid collections in four children. This minimally invasive technique offers a safe alternative to surgery for pancreatic pseudocysts and abscesses.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
Background:
- Lesser sac fluid collections, including pseudocysts and abscesses, are serious complications of pancreatitis in children.
- Traditional management often involves invasive surgical procedures with significant associated morbidity.
Purpose of the Study:
- To evaluate the safety and efficacy of percutaneous transgastric drainage for lesser sac fluid collections in pediatric patients.
- To present this minimally invasive approach as an alternative to surgical intervention.
Main Methods:
- Four children (5-14 years) with lesser sac fluid collections (3 pseudocysts, 1 abscess) underwent percutaneous transgastric drainage.
- Procedures utilized ultrasound or CT guidance and fluoroscopic monitoring for accurate catheter placement.
- External drainage catheters were inserted through the stomach into the fluid collection.
Main Results:
- All four fluid collections, complications of pancreatitis, were successfully drained.
- No major complications occurred; three minor complications (gastric venous bleeding, hematuria, pseudocyst bleeding) were related to catheter reinsertion.
- Surgical intervention was avoided in all cases.
Conclusions:
- Percutaneous transgastric drainage is a safe and effective method for managing lesser sac fluid collections in children.
- Early drainage may reduce morbidity, mortality, and hospitalization associated with pancreatic pseudocysts.
- This technique provides a valuable alternative to surgery in pediatric patients.
Abstract:
In four children (5-14 years old), lesser sac fluid collections (3 pseudocysts and 1 abscess) were externally drained using a percutaneous transgastric approach. With ultrasound or CT guidance and fluoroscopic monitoring, a sheathed needle is inserted through the stomach into the lesser sac fluid collection, the catheter is exchanged, secured in place and connected to external drainage. All four fluid collections were complications of pancreatitis (3 acute post-traumatic, 1 post-surgical). All four fluid collections were successfully drained without need for surgical intervention. There were no major complications. Three minor complications occurred as a result of reinsertion of catheters: transient gastric venous bleeding, hematuria, and bleeding into the pseudocyst. Percutaneous transgastric drainage can be performed successfully in children, and provides an alternative to surgical intervention of lesser sac fluid collections. Drainage early in the course of pancreatic pseudocysts may lessen the morbidity, potential mortality, and prolonged hospitalization usually necessary for standard medical and surgical management of these patients.