Presenter: Paula Jaimes, MD
Email: paula_jaimes@hotmail.com
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Authors: Ivan Molina, MD; Paula Jaimes, MD; Ossiris Gil, MD; Andres Ramirez, MD; Universidad Nacional De Colombia
Introduction: Pancreatic pseudocysts occur as a complication of acute or chronic pancreatitis and are uncommon in children. Symptomatic or persistant pseudocysts may require surgical treatment; laparoscopic and endoscopic modalities have been described, we describe a mixed approach.
Case presentation: We present the case of a 6-year-old boy with pancreatic pseudocyst secondary to pancreatitis after blunt abdominal trauma. The patient presented with abdominal pain, abdominal distension and vomiting. Computed tomography revealed a giant pancreatic pseudocyst. We performed an anterior laparoscopic transgastric approach. A stapled cystogastrostomy was created under laparoscopic and endoscopic vision. Control upper gastrointestinal endoscopy was performed 6 months after without pathological findings.
Discussion: We believe this mixed minimally invasive approach is highly feasible and reproducible in the treatment of pancreatic pseudocysts in children.
Intended audience: Healthcare professionals and clinicians.
Pancreatic cirrhosis drainage with transgastric laparoscopic cystogastrostomy. In this video, we present the case of a six year old boy with pancreatic cirrhosis secondary to pancreatitis due to a severe blunt abdominal trauma caused by a bicycle handlebar. On admission at the ER, the patient presented with abdominal pain, abdominal distention and vomit. An abdominal computed tomography was performed. In these images, we can see the giant fluid collection between pancreas and stomach. The patient was placed in a modified Lloyd Davis position. The surgeon was at the feet of the patient. The assistants were at both sides, and the scrub nurse was at the right side. The monitors were positioned at the patient's head. Ports were placed as follows, 1 in umbilicus, 2 on both flanks. Once in the peritoneal cavity, the anterior surface of the stomach was marked at the level of the entrance at the body for the placement of the trochers. 212 millimeter balloon truckers were inserted on the marked areas under vision of the endoscope as well as the laparoscope, keeping the stomach insufflated with the flexible endoscope. Here we can see the insufflated stomach and inside the tip of the flexible endoscope. A puncture on the posterior gastric wall was done with a suction needle. After confirmation of the location of the cyst an ablation of this incision was done with electrocathery. Clear fluid coming from the pseudocyst was drained. Then, a 45 millimeter endoia was introduced into the stomach and staple cystogastrostomy was achieved. The cease was suction. Finally, gastric ports were taken out from the cavity under endoscopic vision and gastrotomies in the anterior surface were closed with non-observable suture. The surgery had a duration of 3 hours, including anesthesia time. No second look surgeries or interventions were needed. The patient was taken to the intermediate care unit after surgery. At the 4th postoperative day, Dad was well tolerated and received hospital discharge the next day. 6 months later, the patient is asymptomatic and abdominal ultrasound was normal. Control upper gastrointestinal endoscopy was performed without pathological findings. Here we can see the normal continuity of the gastric wall. Although there are multiple modalities of treatment for pancreatic cirrhosis, laparoscopic transgastric cystogastrostomy is a feasible alternative in pediatric patients, especially when there is a giant cyst, minimizing the need for new drainages due to the wider evasion created. We think that the use of this technique is safe in suitable cases for children.
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