Clinical Profile and Management of Children with Pancreatic Fluid Collections: A Retrospective Observational Study

Pancreatic fluid collections (PFCs) are the most common local complications of pediatric pancreatitis. Evidence in children is limited, with most evidence extrapolated from adult studies.

A retrospective study was conducted at a tertiary pediatric surgical center between 2013 and 2024. Children with acute pancreatitis (AP), acute recurrent pancreatitis, or acute-on-chronic pancreatitis (ACP) who developed PFCs were included. PFCs were classified according to the revised Atlanta classification.

Fluid collections were noted in 92 (40%) children. Acute peripancreatic fluid collection (APFC) was the most common type (70%). Acute necrotic collections (ANCs) occurred more frequently in older children (P = 0.013) and presented earlier than APFCs (3.5 ± 2.7 vs. 6.2 ± 5.1 days, P = 0.04). APFCs were more commonly associated with ACP, whereas ANCs predominated in AP (P = 0.004). Fifty-three percent of APFCs progressed to pancreatic pseudocysts (PPCs), and 54% of ANCs progressed to walled-off necrosis (WON). APFC diameter >6 cm and pancreatitis phenotype independently predicted progression to PPC, while PPC diameter >6 cm, ascites, and increasing age predicted the need for intervention. Most children were managed conservatively; symptomatic PPCs and WONs required drainage, predominantly via a percutaneous approach.

PFCs occurred in approximately 40% of children with pancreatitis, most commonly as APFCs. Collections >6 cm in diameter were more likely to progress and require intervention. Percutaneous drainage was a safe and effective modality for symptomatic collections in this cohort.