Endoscopic Drainage And Cystoduodenostomy In A Child Presented With Pancreatic Pseudocyst

Abstract

An 11-year-old morbidly obese boy was diagnosed with pancreatic pseudocyst. Following fine needle aspiration, the cyst recurred in 1-month follow-up. Therefore, endoscopic drainage and cystoduodenostomy was performed following endosonography. Control ultrasonography (USG) revealed a completely shrunken cyst. During the 3 years of follow-up, the patient was asymptomatic with no evidence of cyst on computerized tomography scans. Endoscopic drainage and cystoduodenostomy is a minimally invasive, effective, and safe approach in the management of pancreatic pseudocysts in children.

Trivial injury with devastating complication—A case of pediatric pancreatic pseudocyst

“…If management is not possible without surgical intervention, three surgical strategies can be used to drain the PP, including cysto‐gastrostomy, cysto‐jejunostomy, or cysto‐duodenostomy 11 . Ateş et al managed a patient with a 7 × 6 cm PP initially with ultrasonography‐guided percutaneous aspiration; however, due to the recurrence of the PP, endoscopic drainage and cysto‐duodenostomy were planned 9 . Similarly in our patient, we did a nonsurgical management (external drainage) first, followed by Cysto‐gastrostomy.…”

Pancreatic pseudocyst drainage in children by image-guided cystogastrostomy and stent insertion

“…It has since become the primary therapeutic modality for drainage of pseudocysts [1, 3]. The use of endoscopic ultrasound has evolved more recently [10, 11]. Endoscopic ultrasound can help in finding the optimal site for puncture of the pseudocyst and subsequent stent placement by assessing wall thickness and the distance from stomach or duodenum to pseudocyst, and by identifying major vascular structures [3, 10, 11].…”

“…The use of endoscopic ultrasound has evolved more recently [10, 11]. Endoscopic ultrasound can help in finding the optimal site for puncture of the pseudocyst and subsequent stent placement by assessing wall thickness and the distance from stomach or duodenum to pseudocyst, and by identifying major vascular structures [3, 10, 11]. However endoscopic ultrasound has been limited mostly to diagnostic use in children, with only a few case reports describing its therapeutic role in pseudocysts [3].…”

“…It has been recommended that all cystoenterostomies be stented to avoid recurrence [10]. Often two double-pigtail plastic stents are placed to maintain patency, allow complete resolution of the pseudocyst and minimise the effect of spontaneous stent migration [10], but these often need replacement because of dysfunction and migration [13].…”

“…It has been recommended that all cystoenterostomies be stented to avoid recurrence [10]. Often two double-pigtail plastic stents are placed to maintain patency, allow complete resolution of the pseudocyst and minimise the effect of spontaneous stent migration [10], but these often need replacement because of dysfunction and migration [13]. Further, endoscopic placement of multiple plastic stents can be technically difficult, so the use of a single completely covered self-expanding metallic stent has been proposed as an alternative [13].…”