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Intragastric cystogastrostomy in a 4-year-old child with a pancreatic pseudocyst: A novel technique
Akinori Sekioka1, Toshiaki Takahashi2, Koji Fukumoto2
1Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Shizuoka Prefecture, Japan.
Insights
A novel surgical technique for pediatric pancreatic pseudocysts (PPs) uses intragastric cystogastrostomy with mini-laparotomy. This minimally invasive approach is safe and effective for young children, offering a new treatment option.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Pancreatic pseudocysts (PPs) are uncommon in children, often linked to pancreatitis or trauma.
- Spontaneous resolution is not always achieved, necessitating intervention.
Observation:
- A 4-year-old female presented with a traumatic pancreatic pseudocyst unresponsive to conservative management.
- Existing minimally invasive techniques (laparoscopic, endoscopic) pose challenges in small children.
Findings:
- A novel intragastric cystogastrostomy with mini-laparotomy and wound retractor insertion was successfully performed.
- This technique provided a clear operative field, enabling safe cystogastrostomy in a young child.
- The procedure resulted in no complications, with no recurrence of the PP at 10-month follow-up.
Implications:
- This technique represents a safe, feasible, and minimally invasive option for treating pancreatic pseudocysts in younger pediatric patients.
- It expands the interventional treatment possibilities for pediatric pancreatic pseudocysts, particularly in challenging cases.
Abstract:
Pancreatic pseudocysts (PPs) often occur in association with acute pancreatitis or pancreatic trauma and are uncommon disorders in children. PPs require operative interventions in case they do not disappear spontaneously. There are several interventional treatments, and laparoscopic or endoscopic treatments have been recently reported as a less invasive procedure. However, these procedures are sometimes difficult to perform for small children. We describe a novel intragastric cystogastrostomy with mini-laparotomy for a 4-year-old female child. She presented with a PP caused by trauma. The PP failed to resolve after 6 weeks and we performed open cystogastrostomy. We made mini-laparotomy and inserted a wound retractor into the stomach and expanded both the abdominal and the gastric walls. This procedure created a good operative field and enabled intragastric cystogastrostomy even in small children. There were no complications. At 10-month postsurgery, a follow-up computed tomography showed no recurrence of PP. This novel intragastric cystogastrostomy for PP, which includes the insertion of a wound retractor, is a safe, minimally invasive, and technically feasible approach for younger children with PP. To the best of our knowledge, this is the first report to describe the intragastric cystogastrostomy with a wound retractor.
