Pediatric pancreatic pseudocysts in a resource-limited setting: a multicenter cohort study from Sudan

Pediatric pancreatic pseudocysts (PPCs) are uncommon complications of pancreatic injury or pancreatitis; evidence from resource-limited settings remains scarce. This study aimed to describe the etiology, clinical presentation, management, and short-term outcomes of pediatric PPCs across tertiary pediatric surgery centers in Sudan.

A multicenter retrospective cohort study was conducted across seven tertiary pediatric surgery centers in Sudan between March 2022 and February 2023. Patients younger than 18 years with radiologically confirmed PPCs were included. Demographic, clinical, radiological, management, and in-hospital outcome data were retrospectively extracted from medical records.

Totally, 38 children were included; 27 were male, and 18 were aged 6-10 years. Trauma accounted for 28 cases, most commonly donkey-drawn water cart-related injuries (n=10) and handlebar injuries (n=7). Epigastric pain (n=33) and vomiting (n=31) were the most frequent presenting symptoms, with a median interval of approximately 8 weeks between the initial insult and presentation. Most PPCs measured 6-10 cm (n=24). Open cystogastrostomy (n=17) and ultrasound-guided percutaneous external drainage (n=13) were the predominant interventions; five patients were managed conservatively. Recurrence occurred in one patient, and two patients required reintervention. Two children with severe underlying comorbidities died during hospitalization; neither death was considered directly attributable to the PPC. Non-traumatic PPCs were associated with a significantly different distribution of hospital stay, with a greater proportion requiring prolonged hospitalization (p=0.008).

Pediatric PPCs in Sudan were predominantly trauma related and frequently required intervention. Management should be individualized according to clinical presentation, pseudocyst characteristics, and locally available expertise and resources.