Endoscopic ultasound guided cystogastrostomy in treatment of complicated form of acute pancreatitis in children

Abstract

Acute pancreatitis in children is relatively rare, about 3-13 cases per 100,000 population annually, and complicated forms are three times less common than in the adult cohort of patients. However, recently there has been an increase in the number of acute pancreatitis in the pediatric group, which entails a relatively higher incidence of complicated forms of acute pancreatitis, including the formation of parapancreatic acute fluid accumulations, and determines the relevance of this problem for pediatric surgeons. In this article, using the example of 2 observations, the technology of puncture of a parapancreatic pseudocyst under ultrasound and X-ray control is presented, followed by the introduction of a conductor string into the cavity of the pseudocyst and further stenting of this anastomosis with two plastic double-pigtail stents. In the first case, a 12-year-old boy was operated on with idiopathic pancreatitis and the formation of an acute parapancreatic fluid accumulation in the tail of the pancreas. In the second observation, in a 10-year-old girl, the formation of a parapancreatic pseudocyst occurred as a result of drug-induced pancreatitis (a complication of long-term use of the antiepileptic drug - valproic acid). Both children were operated on using this technique. Antisecretory therapy was carried out in the postoperative period. Catamnesis after 1 year and 6 months: children do not complain, ultrasound and x-ray studies did not reveal any pathology. Conclusion. Endoscopic cystogastrostomy under ultrasound guidance is a method that has found wide application in the complicated course of pancreatitis in adult patients. These observations show its effectiveness in pediatric practice. But the relatively short period of observation of treatment results requires additional research on a much larger number of outcomes of these surgical interventions in children.