Duodenal obstruction: A rare complication of severe acute pancreatitis in children

Abstract

Duodenal obstruction (DO) is an uncommon complication of pancreatitis. It has been described in groove and severe acute and chronic pancreatitis in adults but, to the best of our knowledge, it has not yet been reported in pediatric acute pancreatitis. Current guidelines comment on management of several early and late-onset complications, but DO is not mentioned. We describe two patients with acute necrotizing pancreatitis who presented with several complications including walled-off necrosis and DO. In adults, DO is generally managed with adapted nutrition but may require surgical bypass, such as gastroenterostomy. Our patients were managed conservatively and fully recovered 2 months after DO diagnosis. DO may require lengthy hospitalizations and markedly restrict patients' quality of life; however, prolonged conservative treatment was effective in our patients and should be considered even in severe pediatric cases.

Keywords: acute pancreatitis; complication; conservative treatment; duodenal obstruction.

Figure 1

Gastrointestinal series (Patient 1): Prolonged stenosis of the second duodenum at the time of diagnosis.

Figure 2

Gastrointestinal series (Patient 1): After 7 weeks of conservative treatment showing a partial resolution of the stenosis.

Figure 3

(A) MRI T2 sequence (Patient 2) showing important edema of D2 resulting in the narrowing of the bowel lumen by >90% (arrow) as evidenced on subsequent endoscopy (data not shown). The patient has a cystogastrostomy pigtail stent in place (*) and a stent was inserted in the thrombosed portal vein (**stent extending in the superior mesenteric vein). (B) Follow‐up endoscopy showing progressive regression of the obstruction and edema of the duodenum.