New Delhi: Sachin (name changed), a 10-years old child from Delhi, was admitted at HCMCT Manipal Hospital, Dwarka with acute abdominal pain, recurrent vomiting, and poor appetite for the past one week. The otherwise healthy child bubbling with energy before this episode of pain had a history of pancreatitis, an inflammation of the pancreas three months back and since then he had been suffering from recurrent bouts of abdominal pain.
Parents look for best-in-class treatment for Sachin and he was admitted to Manipal Hospitals. On admission, he underwent a series of diagnostic tests to ascertain the reason behind his pain and that is when an ultrasound showed a cyst in the abdomen below the stomach.
A Magnetic Resonance Cholangio Pancreatogram (MRCP) was performed to confirm the pseudocyst in the pancreas and an endoscopic ultrasound confirmed the presence of a large pseudocyst of the size 13 x 11cm.
Elaborating the advanced procedure, Dr. Lovkesh Anand, Consultant Gastroenterologist, HCMCT Manipal Hospitals, New Delhi said, “Since it was a high risk procedure for the child, informed consent was taken and patient was intubated after adequate sedation and analgesia. After stabilizing the child, cystogastrostomy was performed and a 15 mm × 10 mm cautery-enhanced lumen-apposing metal stent (Hot AXIOS stent) was placed. Immediately after stent deployment, a copious amount of dark fluid (approximately 700 ml), was drained from the cyst”.
The procedure was successfully performed with enormous team effort between the PICU team and Department of Gastroenterology to make it successful. Considerable improvement was witnessed in the patient post-procedure and thus, the child was allowed to go home the very next day after the procedure. Dr. Lovkesh Anand added, “Initially these cysts were usually drained by open surgery, but now less invasive techniques using upper GI endoscopy are available with much less morbidity and good results.”
Dr. Vikas Taneja, HOD-Pediatrics, HCMCT Manipal Hospitals, New Delhi, further explained that Paediatric Pancreatitis is an emerging problem. Pancreatitis can cause the collection of fluid around the pancreas, forming a pancreatic pseudocyst. It is called a pseudocyst because it does not contain the type of cells found in true cysts. “While in some cases pancreatic pseudocysts arise soon after acute or chronic pancreatitis, they often don’t cause symptoms until weeks or months later and are usually found during imaging tests for another problem,” he added.
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