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Management of pancreatic pseudocysts in children
A J Millar1, H Rode, R J Stunden
1Department of Paediatric Surgery, University of Cape Town, South Africa.
Insights
Nearly a third of pediatric pancreatic pseudocyst cases resolved without surgery, monitored via clinical signs and imaging. Persistent symptoms or high amylase levels after 4 weeks suggested failed resolution, guiding further treatment strategies like ERCP and surgery.
Area of Science:
- Pediatric Gastroenterology
- Pancreatic Pathology
- Surgical Management
Background:
- Pancreatic pseudocysts are a known complication in children.
- Management strategies have evolved with advancements in diagnostic imaging.
Purpose of the Study:
- To review the long-term management of pediatric pancreatic pseudocysts.
- To evaluate the efficacy of nonoperative and operative approaches.
- To emphasize individualized treatment strategies.
Main Methods:
- Retrospective review of 25 pediatric cases over 30 years.
- Monitoring included clinical signs, serum amylase, ultrasound, and CT scans.
- Endoscopic retrograde cholangiopancreatography (ERCP) used for non-resolving cases.
Main Results:
- Approximately one-third of cases were managed nonoperatively.
- Persistence of symptoms, signs, and hyperamylasemia for >4 weeks indicated failed resolution.
- ERCP facilitated operative planning for refractory cases.
- Early internal drainage in selected surgical cases was well-tolerated.
Conclusions:
- Nonoperative management is feasible for a subset of pediatric pancreatic pseudocysts.
- Diagnostic imaging and biochemical markers are crucial for monitoring.
- ERCP aids in surgical decision-making.
- Individualized treatment based on clinical course is essential for optimal outcomes.
Abstract:
The management of 25 children with pseudocyst of the pancreas presenting over a 30-year period is reviewed. Nearly a third could be managed nonoperatively, monitoring clinical signs, serum amylase, and in recent years the findings of ultrasound and CT scan. Persistence of symptoms, signs, and hyperamylasemia for more than 4 weeks indicated failed resolution in all but one case. Endoscopic retrograde cholangiopancreatography (ERCP) done in those who did not improve spontaneously facilitated operative strategy. Early operation and internal drainage in selected cases was well tolerated. Individualization of treatment is emphasized.