Pancreatic pseudocyst in a 4-year old boy: case report


Pancreatic pseudocyst is an uncommon condition in childhood and is almost always associated with pancreatitis which may result from trauma or other rare diseases like biliary tract disease, viral illness & drugs or may be related to complications of metabolic diseases. However, unlike adult experience, trauma is the most common cause of pancreatic pseudocysts in children. Most pseudocysts are uncomplicated with few nonspecific symptoms, so they are challenging lesions to diagnose and to treat except when they are large. Therefore, a high index of clinical suspicion is necessary to make an early diagnosis & this require integration of careful medical history, clinical examination and laboratory investigations, but imaging studies such as ultrasound, computed tomography scan & magnetic resonance imaging are very helpful in establishing the diagnosis. Its management is markedly different depending on the cause and size of the cystic lesion of the pancreas. Initially the conservative approach for asymptomatic patients is preferable, on the basis that an appreciable percent of pseudocysts will resolve spontaneously, otherwise different surgical options may be implemented for symptomatic patients or when there are complications. We report a case of a large pancreatic pseudocyst in a four-year-old boy following pancreatitis due to blunt abdominal trauma by a bike injury. The child was treated conservatively for 4 weeks after the development of pancreatic pseudocyst then he underwent an open trans-gastric cystogastrostomy which was very effective and free of complication postoperatively. The presentation, diagnosis and surgical intervention are discussed.