A 7-Year-Old Girl with Early Developed Pseudocyst After Acute Pancreatitis: A Case Report and Literature Review

Abstract

We report a 7-year-old Taiwanese girl with acute pancreatitis (AP) complicated with pseudocyst (PC). The girl was found to have a PC by ultrasonograpgy (USG) and magnetic resonance imaging 14 days after the onset of AP. The girl was discharged 21 days after management with an asymptomatic PC. The diagnostic criteria of AP included abdominal pain, serum amylase or lipase level, and imaging findings. Transabdominal USG after appropriate preparation with adequate fasting, intake of some liquids during the scanning, and right decubitus position enhance the demonstration of pancreas and peripancreatic structures. PC could be seen in up to 38% of pediatric AP patients. It can form within 2 weeks after the onset of symptoms, although most are late complications. Pancreatic PCs have to be differentiated from other intra-abdominal cysts on USG according to their image character and anatomic location. A well-prepared USG examination in combination with liquid intake and right decubitus position is of value in the diagnosis and follow-up of PC. Abbreviations: ANC, acute necrotic collection; AP, acute pancreatitis; APFC, acute peripancreatic fluid collection; CECT, contrast-enhanced computed tomography; CRP, C-reactive protein; CT, computed tomography; MRI, magnetic resonance imaging; PAP, pediatric acute pancreatitis; PC, pseudocyst; USG, ultrasonography.

Keywords: pancreatic pseudocyst; pancreatitis; pediatrics; ultrasonography.

Figure 1

Contrast enhanced computed tomographic (CECT) and ultrasonography (USG) of abdomen done on the day of admission. (A) Horizontal and (B) coronal section showed that the pancreas was edematous with peripancreatic fluid collections (arrowheads). (C) Swelling and blurred margin of the pancreatic body, 1.6 cm in diameter. (D) Hypoechoic area with heterogeneous content between the spleen and the left kidney, indicating pyoascites at splenorenal recess (arrow). LK = left kidney; P = pancreas; S = spleen.

Figure 2

Magnetic resonance imaging (MRI) of abdomen done 14 days after the onset of abdominal pain. A 6 cm × 4-cm well-defined cystic lesion near the pancreas tail with high signal in (A) T2-weighted image (T2WI) and (B) low signal in apparent diffusion coefficient sequence (ADC) (arrowhead), indicating infectious pseudocyst. (C) Focal high signal in T2WI and low signal in ADC (D) at left splenorenal recess, favoring inflammatory ascites (arrows). C = pseudocyst; G = stomach; LK = left kidney; S = spleen.

Figure 3

Ultrasonography (USG) of abdomen. (A) On the 15^th hospital day, a 6.9 cm × 4.6-cm pseudocyst at the pancreatic tail with immature capsule except the wall close to the spleen. (B) On the 20^th hospital day, the 7.2 cm × 3.6-cm pseudocyst was identified after drinking a cup of water and right decubitus position. Note the capsule had become more concrete. C = pseudocyst; G = stomach; S = spleen.