WOFAPS 2025 8th World Congress of Pediatric Surgery

Boukhrissa Nouha, Sfar Sami, Toumi Afef, Ben salah Radhwene, Zouabi Nedra, Krichène Imed, Ksia Amine, Mekki Mongi, Belghith Mohssen, Sahnoun Lassaad

Department of Pediatric Surgery, Monastir University Hospital, Tunisia

Introduction
Pancreatic cysts are rare in pediatric patients and often present with non-specific or absent symptoms, posing a diagnostic challenge. Compression of the bile ducts may lead to cholestasis and, in severe cases, hepatic cirrhosis.

Case Report
A 2-month-old girl was admitted for evaluation of two intra-abdominal cystic masses identified during prenatal imaging, initially thought to originate from the left kidney. Postnatal ultrasound localized the cysts to the left hypochondrium and suggested possible differential diagnoses including digestive duplication, cystic lymphangioma, or ovarian cysts. Abdominal CT revealed two cystic lesions with a "butterfly-wing" appearance in the left hypochondrium, associated with pancreatic microcysts and intrahepatic bile duct dilation, without dilation of the common bile duct. The caudal pancreatic parenchyma was not clearly visualized, raising suspicion for pancreatic cysts, cystic lymphangioma, or digestive duplication.The patient was asymptomatic. Physical examination revealed a palpable, resilient mass in the left flank; other findings were unremarkable. Laboratory tests showed mild hepatic cytolysis. Surgical exploration via a midline incision confirmed two cysts in the body and tail of the pancreas. The pancreatic head appeared indurated, and the liver was firm, nodular, and suggestive of cirrhosis. An accessory spleen was also identified. A body-tail pancreatectomy including cyst excision was performed, along with biopsy of the right hepatic lobe and removal of the accessory spleen. Postoperative recovery was uneventful. Histopathological analysis revealed pseudocysts with chronic pancreatitis and liver cirrhosis with cholestatic features and thrombotic bile ducts.

Conclusion
Pancreatic cysts in infants are often asymptomatic and may be overlooked. Early diagnosis is essential to prevent complications such as biliary obstruction and secondary hepatic cirrhosis.