Available online 15 October 2025, 151565

Author links open overlay panel, , AbstractBackground

Pediatric pancreatic pseudocysts are rare clinically and there is no consensus on an optimum treatment strategy for it. Here, we aim to evaluate the outcome and efficacy of percutaneous external drainage in treating pediatric pancreatic pseudocysts.

Methods

All 62 patients with pancreatic pseudocysts from January 2012 to December 2021, were included. Patients were divided into conservative treatment group (Group A) and external drainage group (Group B). A retrospective analysis was performed based on clinical manifestation and prognosis.

Results

The maximum transverse diameter of cysts was significantly smaller in group A than group B (⁎⁎⁎P < 0.001). The duration of cystic regression was significantly greater in group A than group B (⁎⁎P = 0.013). The curative rate (complete disappearance of all pseudocysts) was 73.5% (25/34) in group A and 88.9% (24/27) in group B. The effective treatment rate (complete disappearance of all pseudocysts or persistence of asymptomatic pseudocysts) was 85.3% (29/34) in group A and 92.6% (25/27) in group B. The existence of fibrous septa in the cyst was an independent risk factor for cyst recurrence after external drainage (⁎⁎P = 0.022).

Conclusion

Conservative treatment is feasible for small asymptomatic pseudocysts; external drainage was safe and effective for large and symptomatic pseudocysts, while the presence of fibrous septa in cysts should be carefully evaluated before external drainage surgery.

Introduction

Pediatric pancreatic pseudocysts (PPPs) are mainly caused by acute and chronic pancreatitis, pancreatic trauma, and pancreatic duct obstruction, but are relatively rare in pediatric patients. Trauma and pancreatitis account for 60 % and 30 % of pancreatic pseudocysts (PPs), respectively, while unknown causes account for 10 %.1 Rupture of the pancreatic parenchyma or pancreatic duct after blunt pancreatic trauma can lead to the accumulation of leaked pancreatic fluid, exudate, necrotic tissue, and blood in the retroperitoneal space, which can stimulate inflammatory responses of the tissues around the pancreas and hyperplasia of fibrous connective tissue, resulting in fibrous effusion wrapped in a pseudomembrane (incidence of up to 44 %).2 At present, the therapeutic principle for PPPs mainly refers to the guidelines for adult PP, which include conservative treatment, ultrasound-guided percutaneous drainage, traditional surgery (internal and external drainage with cyst excision), and endoscopic- or laparoscopic-guided drainage. However, it is crucial to select an appropriate treatment regimen based on the condition of the patient and disease etiology. Here, the outcomes and treatment experiences of 62 PPPs at the Children's Hospital of the Zhejiang University School of Medicine were retrospectively reviewed.

Section snippetsClinical characteristics

The study cohort consisted of 62 PPPs (27 males and 35 females; average age, 8.42 years; age range, 5.50–11.29 years) who were treated at the Department of General Surgery of the Children’s Hospital of Zhejiang University School of Medicine between January 2012 and December 2021. Patients were divided into conservative treatment group (Group A, n = 34) and external drainage group (Group B, n = 27, including 12 cases of laparoscopic external drainage, 12 cases of ultrasound-guided external

Etiology and general information of pancreatic pseudocyst

Maximum median transverse diameter of the cyst was 6.80 cm (4.50–9.50 cm). The cysts of six patients were located at the pancreatic head, 14 at the pancreatic body, 14 at the pancreatic body and tail, and 27 at the pancreatic tail. A fibrous septum within the cyst was observed in 10 patients. Complications included severe fatty liver (three patients), acute severe pancreatitis (five patients), pancreatic contusion and laceration (sixteen patients), contusions of the liver and spleen (two

Discussion

PP usually occurs 2 weeks to 14 months after pancreatitis or pancreatic trauma, with an average of 6 weeks. The development of a PP is a relatively uncommon complication of acute pancreatitis in pediatric patients, but may occur more frequently following pancreatic injury. However, there is no consensus on an optimum treatment strategy for PPPs, thus the selection of conservative treatment, surgical intervention, or percutaneous drainage is determined by the preference of the treating

Ethics statement

This study was carried out in accordance with the recommendations of the Ethics Committee of The Children's Hospital, Zhejiang University School of Medicine [2022-IRB-159] with written informed consent in accordance with Declaration of Helsinki. The protocol was approved by the Ethics Committee of The Children's Hospital, Zhejiang University School of Medicine and informed consent was obtained all from their parents.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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