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Intraoperative ultrasonography of the pancreas in children
Insights
Real-time intraoperative ultrasonography precisely located small pancreatic lesions in children, aiding surgical decisions for insulinomas, pseudocysts, and pancreatitis. This improved surgical outcomes and reduced operative times.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Imaging
Background:
- Pancreatic lesions in children are often small, necessitating precise localization for effective surgical management.
- Accurate identification of pancreatic abnormalities is crucial for planning surgical interventions and improving patient outcomes.
Purpose of the Study:
- To evaluate the utility of newer-generation real-time ultrasonography for intraoperative localization of pancreatic lesions in pediatric patients.
- To assess the impact of intraoperative ultrasonography on surgical decision-making and outcomes for various pancreatic conditions in children.
Main Methods:
- Utilized newer-generation real-time ultrasonography during intraoperative procedures in seven pediatric patients.
- Applied ultrasonography for localization of insulinomas, pancreatic pseudocysts, and ductal abnormalities.
Main Results:
- Ultrasonography successfully localized multiple adenomas in patients with multiple endocrine neoplasia syndrome I (MEN I syndrome), enabling targeted pancreatectomy.
- A nonpalpable insulinoma deep in the pancreatic head was accurately localized, facilitating successful enucleation.
- Intraoperative ultrasonography identified a small pseudocyst, reducing operative time for a patient requiring drainage.
- Ultrasonography revealed spontaneous passage of a pancreatic stone and normalization of duct size, preventing an unnecessary surgical procedure for familial pancreatitis.
Conclusions:
- Real-time intraoperative ultrasonography is a valuable tool for precise localization of small and deep-seated pancreatic lesions in children.
- This imaging modality enhances surgical management of pediatric pancreatic conditions, including insulinomas, pseudocysts, and pancreatitis, leading to improved outcomes and efficiency.
Abstract:
In children, lesions of the pancreas often are small, and precise localization is required for optimal surgical management. We have used newer-generation real-time ultrasonography of the pancreas intraoperatively in seven children. Five of these children had hypoglycemia, hyperinsulinemia, and insulinomas; one had a persistent small pancreatic pseudocyst with a disrupted secondary duct, and one had familial pancreatitis with a remarkably enlarged duct and a stone. Two of the five with adenomas had multiple endocrine neoplasia syndrome I (MEN I syndrome); in them, ultrasonography localized several adenomas preoperatively and several additional adenomas intraoperatively. This allowed a 90% pancreatectomy with enucleation of small adenomas in the remaining head. One child had a nonpalpable insulinoma deep in the head of the pancreas; intraoperative ultrasonography localized the lesion and permitted successful enucleation. Another child with a small pseudocyst and a disrupted secondary pancreatic duct ultimately required surgical drainage; intraoperative ultrasonography of the inflammatory mass immediately localized the small pseudocyst and thus decreased the operative time. The child with familial pancreatitis appeared to require a surgical drainage procedure; however, intraoperative ultrasonography demonstrated that the stone had passed spontaneously just prior to operation and the duct size had returned to normal, eliminating the need for the drainage procedure at that time.