Laparoscopic enucleation of a cystic tumor of the pancreas in a child
Epublication WebSurg.com, May 2016;16(05). URL: http://websurg.com/doi/vd01en4739
This short video describes the laparoscopic enucleation of a benign congenital excretory cyst of the pancreas in a 13-year-old girl. No prenatal diagnosis had been envisaged and this teen girl was admitted in an emergency setting, with iterative abdominal pain followed by vomiting and weight loss (3Kg) over the last two months. The entire work-up allowed to rule out the presence of parenchymal tumor involvement and the perfectly regular isolated and apparently normal nature of a cyst situated on the posterior aspect of the pancreatic head, which is totally separate from the biliary tract and from the duodenum. In these conditions, the diagnosis of Frantz tumor was ruled out and the most probable hypothesis was that of a congenital cystic pancreatic tumor which had recently increased in size. The specificity of the technique used consisted in a pancreatic detachment using a Kocher’s maneuver. The posterior aspect of the pancreatic head was then detached in order to "plicate" or fold the pancreas upon itself. Once turned over 180 degrees to the left, the posterior aspect of the pancreatic head was perfectly exposed. In addition, after puncture of the cyst, the clear fluid content of the cyst was replaced by a blue dye in order to perfectly identify it through a thin layer of pancreatic parenchyma. The cyst’s enucleation was subsequently facilitated. No adhesion impaired its detachment from the remainder of the pancreatic tissue. Since the pericystic area was preserved, the risk of secondary pancreatic fistula was prevented, especially because the cyst had been previously opacified, which allowed to rule out any potential communication with the excretory ducts of the pancreas.