Clinical Profile and Management of Children with Pancreatic Fluid Collections: A Retrospective Observational Study.

BACKGROUND

Pancreatic fluid collections (PFCs) are the most common local complications of pediatric pancreatitis. Evidence in children is limited, with most evidence extrapolated from adult studies.

MATERIALS AND

METHODS

A retrospective study was conducted at a tertiary pediatric surgical center between 2013 and 2024. Children with acute pancreatitis (AP), acute recurrent pancreatitis, or acute-on-chronic pancreatitis (ACP) who developed PFCs were included. PFCs were classified according to the revised Atlanta classification.

RESULTS

Fluid collections were noted in 92 (40%) children. Acute peripancreatic fluid collection (APFC) was the most common type (70%). Acute necrotic collections (ANCs) occurred more frequently in older children (P = 0.013) and presented earlier than APFCs (3.5 ± 2.7 vs. 6.2 ± 5.1 days, P = 0.04). APFCs were more commonly associated with ACP, whereas ANCs predominated in AP (P = 0.004). Fifty-three percent of APFCs progressed to pancreatic pseudocysts (PPCs), and 54% of ANCs progressed to walled-off necrosis (WON). APFC diameter >6 cm and pancreatitis phenotype independently predicted progression to PPC, while PPC diameter >6 cm, ascites, and increasing age predicted the need for intervention. Most children were managed conservatively; symptomatic PPCs and WONs required drainage, predominantly via a percutaneous approach.

CONCLUSION

PFCs occurred in approximately 40% of children with pancreatitis, most commonly as APFCs. Collections >6 cm in diameter were more likely to progress and require intervention. Percutaneous drainage was a safe and effective modality for symptomatic collections in this cohort.