Pancreatic regeneration after near-total pancreatectomy in children with nesidioblastosis.
BACKGROUND
Nesidioblastosis is often resistant to medical therapy and requires near-total pancreatectomy. There is little information on the postoperative imaging findings of these patients.


OBJECTIVE
To demonstrate by US the late imaging findings in these patients.


METHODS
Children diagnosed with nesidioblastosis and who had undergone 90-95% pancreatectomy received preoperative, immediate-postoperative (within 10 days of surgery) and long-term annual US examinations. In the preoperative study, three anterior-posterior (AP) measurements were obtained of the head, body and tail of the pancreas. In the postoperative and long-term follow-up US, AP and transverse measurements of the pancreatic remnant were obtained. Pancreatic echogenicity was also assessed. The results were compared with normal pancreatic dimensions as a function of age. Glucose metabolism and pancreatic enzymes were also analysed.


RESULTS
The study group comprised 22 patients (aged 9 days to 2 years). The pancreas was normal in all preoperative US examinations. The first postoperative examination showed, in all patients, a remnant of the pancreatic head measuring 8-13 mm. The last follow-up US was similar to the first postoperative study in 6 patients, and 12 showed complete pancreatic regeneration (normal size, echogenicity and function), and 4 had incomplete regeneration with head and body normal in size, but lack of a pancreatic tail. All patients were asymptomatic and showed normal laboratory tests.


CONCLUSIONS
US measurements indicated normal age-dependent growth after near-total resection in 54% of patients. The function and echogenicity of the regenerated pancreas indicate that the increase in organ size was due to normal pancreatic tissue.
Department of Radiology, Division of Paediatric Radiology, University Hospital La Paz, Paseo Castellana 261, Madrid 28046, Spain. tberrocal.hulp@salud.madrid.org
Teresa
T
Berrocal
Arturo Alvarez
AA
Luque
Inmaculada
I
Pinilla
Luis
L
Lassaletta
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D046768:Nesidioblastosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010179:Pancreas / Q000000981:diagnostic imaging / Q000502:physiology* / Q000601:surgery*; D010180:Pancreatectomy; D011379:Prognosis; D020127:Recovery of Function; D012038:Regeneration / Q000502:physiology*; D016896:Treatment Outcome; D014463:Ultrasonography