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Pancreas divisum, pancreatic pseudocyst, and choledochal cyst in an 8-year-old child
1Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City.
Insights
This case study highlights a rare presentation of acute pancreatitis in a child. It suggests alternative etiologies for choledochal cysts beyond pancreatic juice reflux.
Area of Science:
- Gastroenterology
- Pediatric Surgery
Background:
- Acute pancreatitis in children is uncommon and requires thorough investigation.
- Choledochal cysts are congenital biliary anomalies often associated with pancreaticobiliary reflux.
Observation:
- An 8-year-old girl presented with acute pancreatitis and large cystic masses near the pancreas.
- Imaging revealed a pancreatic pseudocyst, pancreas divisum, and a choledochal cyst.
- Conservative management failed to resolve the pancreatic pseudocyst.
Findings:
- Surgical intervention included Roux-en-Y pseudocyst-jejunostomy and accessory sphincteroplasty, followed by choledochal cyst excision.
- The patient recovered fully with no recurrence of symptoms a year later.
- The normal pancreaticobiliary ductal junction challenges the sole reflux theory for choledochal cyst formation.
Implications:
- This case expands the understanding of choledochal cyst etiology.
- It underscores the importance of considering complex anatomical variations in pediatric pancreaticobiliary disease.
- Further research into the pathogenesis of choledochal cysts is warranted.
Abstract:
An 8-year-old American Indian girl presented with acute pancreatitis. Ultrasonography and computerized tomography (CT) showed two large cystic masses near the head of the pancreas. During 4 weeks of complete bowel rest and total parenteral nutrition, she had multiple exacerbations of pancreatitis without resolution of the cysts. There were no symptoms of biliary ductal obstruction. Endoscopic cholangiopancreatography (ERCP) showed an 8-cm pancreatic pseudocyst, pancreas divisum, and a 10-cm choledochal cyst. The junction of the common bile duct and the pancreatic duct of Wirsung had a normal relationship. She underwent a Roux-en-Y pseudocyst-jejunostomy and an accessory sphincteroplasty. Three months later, a choledochal cyst excision was performed with biliary reconstruction. The patient is well and asymptomatic 1 year later. This case suggests that pancreatic juice reflux into the common bile duct may not be the only etiology of choledochal cyst formation.
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