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[Pediatric problems arising from surgery of the pancreas in childhood (author's transl)]
Insights
Annular pancreas is a key cause of duodenal obstruction, often treated with duodeno-duodenostomy. Surgical intervention is also vital for pancreatic tumors and nesidioblastosis, with good outcomes for pancreatic trauma.
Area of Science:
- Gastroenterology and Hepatology
- Pediatric Surgery
- Surgical Oncology
Context:
- Annular pancreas is a significant cause of congenital duodenal obstruction.
- Pancreatic malformations and tumors present complex diagnostic and therapeutic challenges.
- Pancreatitis and pancreatic trauma require careful management to prevent complications like pseudocysts.
Purpose:
- To review the central role of annular pancreas in pancreatic malformations and duodenal obstruction.
- To discuss the surgical management of various pancreatic conditions, including tumors and nesidioblastosis.
- To highlight the outcomes of pancreatitis and pancreatic trauma, emphasizing the safety of surgical pseudocyst management.
Summary:
- Annular pancreas accounts for one-third of duodenal obstruction cases, with duodeno-duodenostomy as the primary treatment. Prognosis is affected by prematurity, Down's syndrome, and other malformations.
- Congenital pancreatic cysts, cysto-papillary adenoma, and insulinoma are discussed as key pancreatic tumors, with insulinoma linked to hyperinsulinism and nesidioblastosis. Surgical therapy, including subtotal pancreatectomy for nesidioblastosis, is often required.
- Pancreatitis and pancreatic rupture leading to pseudocysts are also covered, noting that isolated pancreatic trauma and surgical management of pseudocysts have no associated mortality.
Impact:
- Provides a comprehensive overview of pancreatic malformations, tumors, and trauma for clinicians.
- Emphasizes the importance of surgical intervention in managing complex pancreatic diseases.
- Highlights favorable outcomes for specific pancreatic conditions, guiding clinical decision-making and patient counseling.
Abstract:
The annular pancreas which is responsible for one third of the cases of duodenal obstruction plays a central role in pancreatic malformations. Therapy of choice is a duodeno-duodenostomy. Prognosis is deteriorated by frequent premature delivery, Down's syndrome and associated malformations. Among pancreatic tumors the congenital pancreatic cyst, the cysto-papillary adenoma and the insulinoma are particularly considered the latter in connection with the discussion of hyperinsulinism which also nesidioblastosis is associated. Pancreatic tumors to require surgical therapy and a subtotal excision of the pancreas is frequently necessary in nesidioblastosis. Besides pancreatitis which is diagnosed in Germany also pancreatic rupture with subsequent posttraumatic pancreatitis leading to pancreatic pseudocysts is discussed. There are no deaths after isolated pancreatic trauma or surgery of pancreatic pseudocysts.