Post-traumatic pancreatic pseudocyst

Abstract

Introduction. Pancreatic pseudocysts (PPC) developed in 23% of patients following pancreatic trauma and endoscopic retrograde pancreatography demonstrated duct injury in half of these (grade III pancreatic injury). Pancreatitis and PPC formation due to abdominal blunt trauma in children were considered quite rare medical conditions. Methods. We report a case of abdominal trauma in a 9 year old child due to animal aggression (cow dug stroke on the epigastric) that resulted in post-traumatic pancreatitis and PPC formation. We evaluate the objective status of the patient, laboratory and ultrasound examinations, before and after endoscopic treatment. Results. PPC development has been manifested by progressively increasing abdominal pains, vomiting, loss of appetite, significant weight loss. The objective exam relates an underweight patient, moderate mucocutaneous pale, reduced fat tissue, Bichat’s atrophic Bula; abdomen slightly distended, compliant to respiratory movements, deformation of the epigastric contour, sensitive epithelial tumor at the epigastric palpation. At the abdominal US examination was identified the clearly delimited lesion at the pancreas tail, with impure transonic content, without vascular sign, diameter – 5 cm; 15.05.2014 – lesion of the corporeal-caudal pancreas, with impure content, diameter – 10 cm, left kidney pushed back, liquid collection in the recto-vesicular and perihepatic space. Endoscopic treatment consists of trans-gastric punctured of the PPC, and aspirated ≈1 L of impure serum-sanguinous fluid, and mounted 2 drainage prostheses pigtail 10Fr/9cm. Post-interventional evolution, under treatment (antibiotic, antialgic, anti-inflammatory) – good general condition, without fever, resumption of nutrition on day II, with good digestion tolerance, the hospital discharge on the 6`th day post-interventional. Abdominal MRI – no pancreatic pathological fluid collections, without peritoneal fluid collections, normal enter and extrahepatic bile ducts appearance. In 28.07.2014: esophago-duodeno-scopy with extraction of drainage prostheses. Conclusions. Image exploration plays an essential role in the diagnosis, treatment and monitoring of PPC, with significantly lower post-operative recovery and complication rates in endoscopic treatment and marked decrease of the period of hospitalization.