Endoscopie interventionnelle dans les pancréatites de l'enfant

[Endoscopic management of severe pancreatic and biliary diseases in children]

Endoscopic treatment of pancreatic pseudocysts and choledocal lithiasis is a first-line treatment in adults. Nevertheless, due to technical difficulties such a management is not always feasible in children. This series reports our results in the management of pancreatic and biliary diseases in children. Seven children, two months to 12 years old, underwent endoscopic management of pancreatic and biliary diseases. Two of them had choledocal lithiasis with jaundice or acute pancreatitis, two had pancreatic pseudocyst due to abdominal traumatism, two had chronic pancreatitis with a communicating pseudocyst in one case, and one had a biliary leakage after traumatism. All the endoscopic treatments were performed under general anesthesia. In six cases, the duodenoscope was a regular one with a large operating channel (Olympus TJF 160; Japan) employed for children aged 33 months to 12 years. In the case of the two months child, a "rendez-vous" technique was performed with a percutaneous approach of the common bile duct followed by an endoscopic sphincteroclasy using an axial endoscope allowing the extraction of a choledocal stone. In two cases, post-traumatic pancreatic pseudocysts (eight and 12 year-old children) were managed with the transgastric insertion of two double pig-tail stents. In two cases, children with chronic pancreatitis (38 months and 12 years old) were managed with pancreatic sphincterotomy. Biliary leakage in an 11-year-old child was managed with biliary sphincterotomy and stenting. All the children became symptom-free without any procedural complications with an 11 months median follow-up. Endoscopic treatment of pancreatic and biliary diseases is possible in children like in adults with the same procedures and results.

Laparoscopic cystojejunostomy as a treatment option for pancreatic pseudocysts in children--a case report

Pancreatic pseudocysts are a rare entity in children for which many approaches have been described. We report on the case of a 5-year-old boy with a pancreatic pseudocyst after blunt abdominal trauma. The patient's clinical and laboratory examination findings had also revealed an acute pancreatitis. His diagnostic workup included ultrasound examination and magnetic resonance cholangiopancreatography. Two large cysts were found at the tail of the pancreas. No injury of the pancreatic or bile duct was found. The child underwent successful laparoscopic cystojejunostomy. The patient was free of complaints after more than 2 years of follow-up. Laparoscopic cystojejunostomy in children with pancreatic pseudocysts may represent an alternative treatment option for large pancreatic pseudocysts.