title: Prevalence, Natural History, and Outcome of Acute Fluid Collection and Pseudocyst in Children With Acute Pancreatitis.
abstract: OBJECTIVE
  Recent years have witnessed an increase in acute pancreatitis (AP) in children; however, the natural history of acute fluid collection (AFC) and pseudocyst is largely unknown. We evaluated the frequency, clinical characteristics, and natural history of pseudocysts in children with AP.
  
  
  METHODS
  Children with AP admitted at Sanjay Gandhi Postgraduate Institute of Medical Sciences from 2001 to 2011 were enrolled and studied until complete resolution. Subjects with inadequate follow-up, recurrent AP, and chronic pancreatitis were excluded.
  
  
  RESULTS
  Of the 58 children (43 boys, median age 14 [1-18] years) with AP, 34 (58.6%) and 22 (38%) developed AFC and pseudocyst, respectively. No difference in age (12 [4-18] vs 13 [1-16] years), etiology (idiopathic 64% vs 47% and traumatic 27.2% vs 22.2%), and systemic complications (pulmonary [18% vs 11%], renal [22.7% vs 11%], and shock [13.6% vs 10%]) was observed between children with and without pseudocyst. A total of 11 of the 22 subjects with pseudocyst underwent drainage, the commonest symptom requiring drainage being gastric outlet obstruction [n = 5] and infection [n = 2]. The 11 of the 22 children with AP and pseudocyst (size 6.4 [3-14.4] cm) showed spontaneous resolution (disappearance [n = 9] and significant reduction in size [n = 2]) during 110 (25-425) days. Symptomatic pseudocysts requiring drainage were more often secondary to traumatic AP (6/6 vs 2/14 [idiopathic], P = 0.0007) than asymptomatic pseudocysts resolving spontaneously. Overall, only 26.4% (9/34) children with AFC required drainage because of symptomatic pseudocyst.
  
  
  CONCLUSIONS
  Among children with AP, 58.6% developed AFC and 38% developed pseudocysts. Only patients with symptomatic pseudocyst need drainage, and asymptomatic pseudocyst can be safely observed irrespective of size and duration of collection.
authors.affiliation: Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Rishi
authors.initials: R
authors.lastname: Bolia
authors.forename: Anshu
authors.initials: A
authors.lastname: Srivastava
authors.forename: Surender Kumar
authors.initials: SK
authors.lastname: Yachha
authors.forename: Ujjal
authors.initials: U
authors.lastname: Poddar
authors.forename: Sheo
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D058070:Asymptomatic Diseases; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D008297:Male; D008499:Medical Records; D010192:Pancreatic Pseudocyst / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D010195:Pancreatitis / Q000503:physiopathology*; D019152:Paracentesis / Q000009:adverse effects; D015995:Prevalence; D012075:Remission, Spontaneous; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D057832:Watchful Waiting