Pseudocyst of the pancreas in childhood

Abstract

An 8-year-old boy was admitted to BMH Rinteln with severe left upper quadrant pain. He gave a history of having been kicked in the abdomen by his brother during play 3 weeks previously. The pain had become worse and he then developed anorexia, listlessness and had lost 3 kg in weight. On examination he was pale an had an obvious tender diffuse mass involving the epigastrum and left upper quandrant. Investigations: ESR = 48 in first hour, Hb = 13.2 gram per cent, WBC = 6.0 x 109/l. An IVU was normal but ultrasound scan showed a transonic collection anterior to the superior pole of the left kidney consistent with the clinical diagnosis of a subcapsular splenic haematoma. For 5 days his symptoms improved only to deteriorate over the subsequent 2 weeks with anorexia and vomiting. The blood profile was normal except an ESR = 32 and a polymorph leucocytosis of 83%. Repeat ultrasound scan showed one large cyst and several smaller cysts in the splenic region. Barium meal suggested there was a mass behind the stomach displacing it forward. At this stage the plasma amylase = 3089 International units. Laparotomy confirmed the presence of a large lesser sac cyst (pseudocyst) with multiple smaller cysts of the pancreas each 2-3 cms in diameter. The smaller cysts of the pancreas were marsupialised and the lesser sac was drained through a wide bore tube drain to the exterior through a separate stab incision. Postoperatively he made slow but steady progress. An external fistula formed in the laparotomy wound 2 weeks following operation but resolved over 3 weeks. Ultrasound scan at this stage showed resolution of the cysts, Hb = 12.2 gm%, WBC = 5.0 x 109/L and amylase = 257 Somogyi units. The patient has made a complete recovery.