Post written by Ryan Law, DO, from the Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA.
An 8-year-old boy was referred for abdominal pain of unclear etiology, dysphagia, and failure to thrive. He had multiple visits to the emergency room over a 5-year period for abdominal pain of unclear etiology. After routine evaluation for common etiogies, he underwent MR enterography which demonstrated a bilobed fluid collection superior to the pancreas with a component near the gastric body in continuity with a component in the mediastinum. This was thought to be a pancreatic fluid collection following an undiagnosed bout of acute pancreatitis. Prior evaluation of amylase/lipase were elevated but non-diagnostic for acute pancreatitis. He was subsequently diagnosed with hereditary chronic pancreatitis. We elected to perform EUS-guided drainage of his pancreatic fluid collection.
We felt it was important to recognize that, while less common, sequelae of acute pancreatitis and the therapeutic interventions needed for treatment can occur in children. This case demonstrates EUS-guided intervention for treatment of pancreatic pseudocyst, something we don’t expect to see in an 8-year-old patient.
Other endoscopists can learn that similar techniques performed in the adult population can be translated to pediatric patients. However, certain techniques, such as the one presented, have the potential for adverse events and should only be performed if less invasive alternatives have been exhausted.
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