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Pancreatic ascites in children
A J D'Cruz1, P S Kamath, C Ramachandra
1Department of Pediatric Surgery, St John's Medical College Hospital, Bangalore, India.
Insights
Pancreatic ascites in children, a rare condition causing severe malnutrition, can be effectively treated with surgery. Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for diagnosis and surgical planning.
Area of Science:
- Pediatric Gastroenterology
- Surgical Interventions
Background:
- Pancreatic ascites is a rare but serious complication in children, often presenting with intractable ascites, malnutrition, and significant weight loss.
- Diagnosis relies on elevated ascitic fluid and serum amylase levels, with endoscopic retrograde cholangiopancreatography (ERCP) essential for identifying pancreatic duct disruption and pseudocysts.
Observation:
- Three pediatric patients with pancreatic ascites, confirmed via ERCP, underwent surgical management.
- Surgical approaches included stented transgastric pseudocyst drainage and Roux-en-Y cystojejunostomy, with one case requiring revision surgery for a recurrent pseudocyst.
Findings:
- All three children achieved complete resolution of ascites and experienced significant improvement in nutritional status post-surgery.
- Long-term follow-up confirmed sustained pain relief and absence of ascites, indicating successful surgical outcomes.
Implications:
- Pancreatic ascites should be strongly considered in the differential diagnosis of pediatric ascites.
- ERCP plays a vital role in the diagnostic and management planning of pancreatic ascites.
- Cystoenterostomy represents a definitive and effective treatment for pediatric pancreatic ascites, leading to favorable long-term prognoses.
Abstract:
We report on three children with pancreatic ascites confirmed by endoscopic retrograde cholangiopancreaticography (ERCP) and treated with surgery. The children presented with ascites, malnutrition and severe weight loss. Pancreatic ascites was diagnosed by elevated ascitic fluid and serum amylase levels. ERCP demonstrated a pseudocyst and the site of disruption of the pancreatic duct, but not the etiology of the pancreatitis. Following a period of nutritional support, surgery was carried out. Two of the children underwent a stented transgastric drainage of the pseudocyst; a recurrent pseudocyst in one of the children required a revision cystojejunostomy. The third child was treated with a Roux-en-Y cystojejunostomy. All the children are pain-free and without ascites and are doing well on long-term follow-up. We conclude that pancreatic ascites must be considered in the differential diagnosis of intractable ascites in children. An ERCP is essential in planning management and cystoenterostomy is the definitive treatment.