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Pancreatic disorders in infancy and childhood: experience with 92 cases
D W Vane1, J L Grosfeld, K W West
1Department of Surgery, Indiana University Medical Center, Indianapolis.
Insights
This 10-year study of pediatric pancreatic disorders found that while blunt trauma caused pseudocysts, medical conditions like pancreatitis were more common. Most children survived, with treatments tailored to specific pancreatic conditions.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Pancreatic disorders in children are diverse, encompassing trauma, medical conditions, and neoplasms.
- A 10-year review was conducted to analyze treatment and outcomes for pediatric pancreatic diseases.
Purpose of the Study:
- To review the management and outcomes of 92 children with various pancreatic disorders.
- To evaluate the effectiveness of different treatment modalities for pediatric pancreatic conditions.
Main Methods:
- Retrospective analysis of 92 pediatric patients treated over 10 years.
- Categorization of disorders into blunt trauma, medical, metabolic, or neoplastic diseases.
- Review of diagnostic imaging (CT, US) and surgical/non-surgical interventions.
Main Results:
- Blunt trauma (33 patients) often led to pseudocysts, while medical conditions (69 patients) included pancreatitis, neoplasms, and nesidioblastosis.
- Pseudocysts were managed with observation, aspiration, drainage, or resection.
- Neoplasms and nesidioblastosis required surgical intervention, including resection.
- Pancreatitis causes varied (familial, idiopathic, medication-induced, gallstones, choledochal cysts), with resolution often achieved conservatively or after biliary intervention.
- Computed tomography (CT) and ultrasound (US) were key diagnostic tools.
- Overall survival rate was 95%.
Conclusions:
- Pediatric pancreatic disorders require tailored management based on etiology and presentation.
- Imaging modalities like CT and US are crucial for diagnosis.
- Surgical intervention is indicated for neoplasms, duct abnormalities, and recurrent pancreatitis.
- Conservative management and specific procedures are effective for pseudocysts and pancreatitis.
Abstract:
Ninety-two children with pancreatic disorders were treated over a 10-year period. Thirty-three had blunt trauma, while 69 had medical, metabolic, or neoplastic diseases. Children with trauma had either duct disruption (3), gland fracture (4), or pseudocysts formation (26). Operation was required in 30. Pseudocysts were treated with observation alone in three cases, ultrasound-guided percutaneous aspiration in three, surgical external drainage in two, distal pancreatectomy in four, cyst gastrostomy in ten, and cyst-Roux-en-Y jejunostomy in six. Other disorders included pancreatitis (44), neoplasms (10), nesidioblastosis (4), and pancreaticosplenic abscess (2). Treatment for neoplasms included surgical excision in nine and biopsy in one (adenocarcinoma). Patients with nesidioblastosis underwent 95% (near total) pancreatic resection (two after previous unsuccessful 80% resection). Pancreatitis was familial in two cases, necrotizing in two, idiopathic in 11, and secondary to medications in six cases (steroids, 2; L-asparaginase, 4), gallstones in 17, and choledochal cysts in 6. Pancreatitis resolved after observation and conservative therapy in ten idiopathic cases, 4/6 medication-related cases, and following correction of biliary tract disease (15/17) or choledochal cysts (6). Pancreatic resection or drainage was required in the remaining cases. Pancreatic disorders can be accurately detected with computed tomography (CT) scan in most cases (excluding insulinoma). Ultrasound (US) is useful in cases of biliary tract disease and pseudocyst formation. Traumatic pseudocysts can resolve spontaneously or with US-guided percutaneous drainage (in the presence of normal ducts). Children with neoplasms, abnormal pancreatic ducts, or recurrent pancreatitis require resection or appropriate drainage procedures. Overall survival was 95%.