Pancreatic pseudocysts in children

Abstract

Pancreatic pseudocyst (PPC) is an uncommon condition in childhood and is almost always associated with blunt abdominal trauma. Additional disease within the pancreas is rare, unlike adult experience. Prior to the advent of ultrasonography (US) assessment of the cyst was difficult. Subsequently, it has become apparent that PPC may develop but still undergo spontaneous regression. We have reviewed eight children with PPC seen at the Royal Children's Hospital between 1967 and 1987: six males and 2 females ranging in age from 2 to 12 years. The aetiology was blunt abdominal trauma in seven cases and idiopathic pancreatitis in one. Four children presented acutely and the diagnosis of PPC was made by US within 10 days of admission. One of these children had a diagnostic laparotomy for traumatic pancreatitis and his PPC was identified subsequently on serial US. The PPC in this child and one other resolved spontaneously after a period of total parenteral nutrition and intestinal rest. In two cases, the PPC failed to resolve and drainage was necessary. Late presentation (5–16 weeks) after recognised injury occured in four children; all required surgery within 1 week of admission. No surgical complications occured. Conservative management of PPC has been condemned because of the risk of complications occurring during the waiting period. This applies to adults who have developed a PPC in a pancreas diseased due to alcohol and/or cholelithiasis; the natural history of PPC is quite different in children. We thus recommend a trial of conservative treatment for all children who develop a PPC early, but consider that surgery is the best choice for those who present later.