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PEDIATRIC PANCREATIC PSEUDOCYST PRESENTATION AND PROCEDURAL MANAGEMENT
Kristen N. Kaiser
*3,2,1, Rhea Gupta
2, Ella Boardley
2, Ryan J. Ellis
3,1, Brian A. McFerron
2, Thomas K. Maatman
1, Alan Ladd
2, Brian Gray
21General Surgery, Indiana University, Bloomington, IN; 2Riley Hospital for Children at Indiana University Health, Indianapolis, IN; 3Surgical Outcomes and Quality Improvement Center, Indianapolis, IN
Background Treatment options for pancreatic pseudocysts (PP) include endoscopic intervention, image-guided drainage, and operative interventions. While indications and interventions are established in the adult population, standard of care is not defined on how PPs are managed in the pediatric population. This study aims to (1) define rates of procedural intervention for PPs, and (2) describe differences in characteristics and presentation when comparing patients who underwent procedural intervention compared to supportive management alone.
Methods Pediatric patients with PPs treated at a single pediatric hospital from 2005–2022 were retrospectively reviewed. Patients were identified by ICD 9 & 10 codes for PP and included if they developed PP following pancreatitis. Data collected included demographics, interventions, and imaging characteristics of the pseudocyst. Outcomes of interest included nasojejunal feeding and recurrence. Associations between procedural interventions and outcomes were then assessed using chi-squared, Fischer exact test and Wilcoxon rank sum.
Results A total of 68 pediatric patients with PPs were identified. Patients were mostly female (57%) and had a median age of 13.2 years (IQR 8.8-15). The most common cause of pancreatitis leading to PP was drug-induced (e.g. chemotherapy; 37%, n=18), followed by gallstones (27%, n=13). Procedural intervention occurred in 55% (n=38) of patients. Of those patients, 39% (n=15) underwent endoscopic interventions, 42% (n=16) underwent surgery, and the remainder had image-guided drainage (29%). There were no differences in age, sex, race, or age across procedural interventions. Of patients who underwent a drainage procedure and had follow-up information (n=28), 93% had complete resolution without recurrence. Patients undergoing procedural intervention were more likely to undergo imaging (CT: 89% vs. 57%, p=0.002, MRI: 42% vs. 30%, p=0.3, US: 61% vs. 47%, p=0.3). Pseudocysts were significantly larger in patients who underwent procedural intervention than those who did not (median 10.3 cm vs. 5.8 cm, p=0.003). One recurrence was following endoscopic intervention, and one recurrence was following surgical intervention. Procedural intervention was associated with pain four weeks after pancreatitis presentation (73% vs. 13%, p<0.001) and usage of nasojejunal feeding (72% vs. 41%, p=0.04).
Conclusion Pancreatic pseudocysts are heterogeneous in presentation in the pediatric population, but pain and size may impact management. These data represent a large pediatric PP series and may aid in decision making for proceeding to procedural intervention.
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