Duodenal Diverticula (DD) are referred to rare clinical observations in pediatric practice. The article presents two clinical cases of extra-luminal true DD in children. There is described an experience of using laparoscopy in the treatment of a combined anomaly of the bile ducts and cysts of choledochus and DD in a child of 10 years and an extraluminal DD in a child of 12 years.
Introduction. Pancreatic pseudocysts are encapsulated fluid sacs in the omentum having no epithelial lining; they appear in the pancreas after injury and inflammation. Recently, there has appeared a trend to treat pancreatic pseudocysts with laparoscopic surgical interventions. The article describes laparoscopic treatment of pancreatic pseudocysts in 10 children. Objective. To evaluate the effectiveness of laparoscopic interventions in children with pseudocysts in the pancreas. Material and methods. In 2013-2018, 10 laparoscopic surgeries in children, aged 4-17 (5 boys and 5 girls), with pancreatic pseudocysts were performed at the department of pediatric surgery in the Russian Medical Academy of Continuous Professional Education. Indications for surgery were: pancreatic pseudocysts having diameter more than 6 cm and wall thickness more than 3-4 mm, no effect after the conservative therapy , cyst formation more than 3 months, persistent pain syndrome. Results. The choice of a surgical technique was defined by pseudocyst etiology and location. The children had six laparoscopic cystoeunoanastomoses, two partial cystectomies with a distal pancreatojejunoanastomosis and two partial cystectomies with a longitudinal pancreatojejunoanastomosis when the cyst was formed at the chronic pancreatitis. No intraoperative complications were seen. Early postoperative complications occurred in 2 patients: an external pancreatic fistula at the drainage site (1) and intestinal obstruction (1) at the level of the intestinal anastomosis. Conclusion. Laparoscopic surgeries in children with pancreatic pseudocysts are effective and less traumatic. The laparoscopic technique allows to make a complete revision, to perform sequestrnecrectomy , if necessary, as well as to take the material for histological examination and to ensure a reliable long-term drainage.
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