Laparoscopic Roux-en-Y cysto-jejunostomy in a complicated Pancreatic Pseudocyst following SARS-CoV-2 virus pancreatitis in a child

ABSTRACT

Background: Pancreatic pseudocyst (PPC) is the rare complication of pancreatitis. Unlike to adults, it is ensued due to malunion of pancreatic ducts, autoimmune or frequently post-traumatic. During follow up although it might resolve by conservative treatment, may necessitate interventional approaches. Even endoscopic or percutaneous treatments have been the first line treatment, surgery is inevitably necessary in case of complicated or>6 cm diameter. In this study laparoscopic Roux-en-Y cysto-jejunostomy (LRYCJ), to complicated PPC that did not respond to percutaneous drainage, has been presented. Method(s) A 15-year-old boy had been admitted to state hospital with the complains of vomiting, epigastric pain two weeks after SARSCoV- 2 (SARSC2) virus infection. He has been following due to Autism. Initially he had been treated conservatively due to pancreatitis. One month after, PPC (20 mm) distal to pancreas had been specified. He was referred to our department as the cyst got bigger (75 mm) with recurrent complains. No ductal connection was identified however thrombosis of splenic vein, dilated collateral and distal esophageal variceal veins was detected. Ultrasound guided percutaneous drainage has been performed however two weeks after, 95175 mm PPC at the same location was detected. LRYCJ was performed with four ports via suspending stomach and transvers colon. While Roux-en-Y has been performed through expanded umbilical incision cysto-jejunostomy was intracorporeally performed. Penrose drain was left close to cysto-jejunostomy. Oral feeding has begun on postoperative day 2, drain was removed on day 3. Fullfed and discharged on postoperative day 4. Patient did well after a follow up of 3 months. Conclusion(s) Consequently, our case is the first reported PPC following pancreatitis owing to SARSC2 virus infection. Even endoscopic or percutaneous drainage is the most preferred approach for PPC, in case of large cyst or complicated ones, cysto-jejunostomy could be applied by minimally invasive approach in children also.