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Radiological and surgical management of bleeding pancreatic pseudocyst in a pediatric patient

V Alonso1, D Guéye2, V Monnin3

  • 1Pediatric Surgery Department, Valladolid Clinical University Hospital, Valladolid (Spain).

Cirugia Pediatrica : Organo Oficial De La Sociedad Espanola De Cirugia Pediatrica
|July 13, 2021
PubMed

Insights

Pediatric pancreatic trauma can lead to giant pseudocysts. This case highlights the successful radiological and surgical management of a large traumatic pancreatic pseudocyst with intracystic bleeding.

Area of Science:

  • Pediatric surgery
  • Trauma surgery
  • Gastroenterology

Background:

  • The pancreas is the fourth most frequently injured solid organ in pediatric abdominal trauma.
  • Traumatic pancreatic injuries require careful management due to potential complications.

Observation:

  • A 13-year-old male developed a giant pancreatic pseudocyst (170x86x180 mm) following grade IV pancreatic injury.
  • The patient experienced intracystic bleeding, abdominal compartment syndrome, biliary leak, and chemical peritonitis.

Findings:

  • Radiological embolization of the gastroduodenal artery successfully managed intracystic bleeding.
  • Laparotomy and drainage were necessary for abdominal compartment syndrome, biliary leak, and peritonitis.
  • Pancreatitis and duct fistula showed slow but favorable recovery.

Implications:

  • Giant pancreatic pseudocysts (>200 mm) may necessitate surgical intervention.
  • Intracystic bleeding is a rare but life-threatening complication of pancreatic trauma.
  • Selective angiography is a valuable tool for improving prognosis in such cases.
Abstract

Keywords:
Biliary fistulaPancreatic pseudocystPancreatitisPeritonitisTherapeutic embolization

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