Pancreatic pseudocyst in children: the impact of management strategies on outcome.

INTRODUCTION: Persistent pancreatic pseudocysts (PPs) are rare in childhood and management tends to be individualized. The purpose of this review is to determine the impact of different management strategies and to analyze their effects on patient outcomes.

METHODS: An institutional review board-approved retrospective chart review was performed on children younger than 18 years who had PP diagnosed between January 1976 and December 2003.

RESULTS: There were 24 patients, 13 male and 11 female, with a mean age 10.7 years (range, 2-17 years). The mean PP size was 5.8 cm (range, 1.7-20 cm). Posttraumatic pseudocysts were identified in 11 children. The etiologies of 13 nontraumatic PP were idiopathic (6), familial pancreatitis (4), drug-induced (1), cholelithiasis (1), and bifid duct (1). All patients were symptomatic at diagnosis. Resolution of pseudocysts without operative intervention occurred in 7 (29%) of 24 patients. The mean time to operation for the remaining 17 children (71%) was 13.1 weeks (range, 6-36 weeks), with indications for intervention including persistent/recurrent abdominal pain (17), failure to thrive (9), infected PP (1), and ruptured PP (1). Surgical therapies for 13 of 17 patients consisted of cystogastrostomy (8), cystojejunostomy (2), longitudinal pancreaticojejunostomy (2), and Frey's procedure (1). Four patients underwent pancreatic sphincterotomy and stenting, 2 of whom also had image-guided pseudocyst drainage. The intervention-related mortality and morbidity rates were 0% and 11%, respectively, for children undergoing surgical therapies. The morbidities included pancreatic leak (1) and wound infection (1). Etiology of the PP had a significant influence on the need for intervention (traumatic, 45%; nontraumatic, 92%; P = .02); however, patient age, size, and location of the PP had no significant effect. All 24 patients continued to do well at mean follow-up of 73.3 months (range, 6 weeks-25 years). One patient with idiopathic pancreatitis has since developed insulin-dependent diabetes. All 4 patients with familial pancreatitis had their chronic pain improved without long-term narcotic therapy.

CONCLUSION: The treatment of PPs in children is dependent on etiology, where pseudocysts from nontraumatic etiologies are more likely to require and benefit from surgical interventions, whereas pseudocysts from traumatic etiology are more amenable to conservative management. For children with persistent symptoms or interval complication, surgical therapy is safe and effective.