Percutaneous transgastric drainage of the lesser sac in children

Abstract

In four children (5-14 years old), lesser sac fluid collections (3 pseudocysts and 1 abscess) were externally drained using a percutaneous transgastric approach. With ultrasound or CT guidance and fluoroscopic monitoring, a sheathed needle is inserted through the stomach into the lesser sac fluid collection, the catheter is exchanged, secured in place and connected to external drainage. All four fluid collections were complications of pancreatitis (3 acute post-traumatic, 1 post-surgical). All four fluid collections were successfully drained without need for surgical intervention. There were no major complications. Three minor complications occurred as a result of reinsertion of catheters: transient gastric venous bleeding, hematuria, and bleeding into the pseudocyst. Percutaneous transgastric drainage can be performed successfully in children, and provides an alternative to surgical intervention of lesser sac fluid collections. Drainage early in the course of pancreatic pseudocysts may lessen the morbidity, potential mortality, and prolonged hospitalization usually necessary for standard medical and surgical management of these patients.

Indian College of Radiology and Imaging Consensus Guidelines on Interventions in Pancreatitis

“…The transgastric route for drainage of pancreatic collections is less commonly employed. 76 77 However, in patients with ANC who are not candidates for retroperitoneal or transperitoneal, drainage may benefit from transgastric drainage. In a recent study by Sugimoto et al, transgastric PCD was performed in 54% of the patients.…”

Percutaneous Drainage of Abdominal and Pelvic Abscesses in Children

“…51 Although limited outcome data are available for pediatric patients, several authors have described successful percutaneous management of pancreatitis complications in children. [52][53][54] Patients with IN have historically been treated with surgical debridement. 55 However, successful nonsurgical management of IN with percutaneous drainage, endoscopic drainage, and/or endoscopic necrosectomy has been described in adults.…”

“…6,12,21,78 The approach may be chosen based on abscess location and operator experience and preference. 52,80,83 PAD catheters should generally be placed using an approach that avoids transgressing adjacent critical structures, facilitates gravity drainage, and minimizes patient discomfort. [84][85][86] However, some procedures may require catheter placement via approaches that transgress adjacent organs.…”

“…For example, lesser sac collections complicating acute pancreatitis can be safely approached by transgastric and transhepatic routes. 46,52,83,87 Acute appendicitis is the most common cause of deep pelvic abscesses in children. 80,85,88 Pelvic abscesses in children can be drained via a variety of specific routes including transgluteal and transrectal approaches.…”

Management of Childhood Pancreatic Disorders: A Multidisciplinary Approach

“…Complications of acute and chronic pancreatitis (AP and CP), which contribute significantly to morbidity and mortality, have been successfully managed by a combined approach. There are relatively limited published data regarding the usefulness of therapeutic endoscopy and radiologic interventions for the management of AP and CP in children (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Our study focuses on the presentation, diagnosis, and multidisciplinary approach to the management of acute and chronic pancreatic disorders in children.…”