Intervention for Pancreatic Fluid Collections Following Moderately Severe Acute Pancreatitis in Adolescents: A Case Series

A BSTRACT Acute pancreatitis is increasingly recognised in paediatric and adolescent populations and may result in substantial local complications. According to the revised Atlanta classification-2012, the presence of acute pancreatitis with local collections constitutes moderately severe acute pancreatitis. Evidence guiding intervention in this population remains limited. We present retrospective cases of three adolescents (12–18 years) with moderately severe acute pancreatitis managed at our institution over a 3 month period. Clinical presentation, imaging findings, management, and outcomes were analysed. The manuscript was prepared in accordance with CARE guidelines. Three patients with complicated acute pancreatitis were included. One patient with a large pancreatic pseudocyst underwent open cystogastrostomy, and two patients with infected pancreatic fluid collections were managed with image-guided pigtail drainage because of infection and persistent symptoms. At follow-up, all patients were doing well and remained asymptomatic, with no evidence of pancreatic fistula among those who underwent pigtail drainage. A tailored approach may be effective in managing complicated moderately severe acute pancreatitis in adolescents. In our series, percutaneous drainage provided good clinical outcomes for infected collections, and open cystogastrostomy was reserved for large symptomatic pseudocysts. Further studies are needed to establish age-specific management guidelines.