Conservative Management of Blunt Pancreatic Trauma in Children: A Single Center Experience

 

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Abstract

Introduction Blunt trauma of the pancreas represents a significant part of abdomen trauma in children with an incidence estimated at around 10%. If the conservative management is widely accepted concerning the stages I and II, it remains controversial concerning stages III and IV. The aim of our study was to perform a descriptive analysis of the nonoperative management, with a focus on the occurrence of pseudocysts.

Materials and Methods The charts of the patients treated in our center for pancreatic trauma from 1990 to 2010 have been reviewed. It was defined by an initial lipase greater than three times the norm and an abnormal computed tomography scan.

Results A total of 36 patients were included, with 26 boys (72%) and 10 girls (28%) with an average age of 8.7 years. The trauma was isolated in 13 cases (36.1%) and in 23 cases, there were other associated lesions (mainly liver [n = 9] and spleen [n = 5]). Pancreatic injuries were graded as follows: I (n = 21), II (n = 2), III (n = 7), and IV (n = 6). Pseudocysts occurred in 11 patients (30.5%) mainly in grades III (n = 3) and IV (n = 7), with an average delay of 17 days. Initial management of pseudocysts was conservative in six patients (54.6%), whereas five patients required mimi-invasive procedures.

Conclusion Nonoperative management remains a safe way to treat pancreatic injuries despite an average 30% rate of pseudocyst (PC) appearance. It allows a reduction in the number of children who required procedures to less than half of the patients where PC occurred. Furthermore, these procedures were exclusively mini-invasive.

• References

• 1 Mattix KD, Tataria M, Holmes J , et al. Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes. J Pediatr Surg 2007; 42 (2) 340-344
  CrossrefPubMedGoogle Scholar
• 2 Tataria M, Nance ML, Holmes IV JH , et al. Pediatric blunt abdominal injury: age is irrelevant and delayed operation is not detrimental. J Trauma 2007; 63 (3) 608-614
  CrossrefPubMedGoogle Scholar
• 3 Sutherland I, Ledder O, Crameri J , et al. Pancreatic trauma in children. Pediatr Surg Int 2010; 26 (12) 1201-1206
  CrossrefPubMedGoogle Scholar
• 4 de Blaauw I, Winkelhorst JT, Rieu PN , et al. Pancreatic injury in children: good outcome of nonoperative treatment. J Pediatr Surg 2008; 43 (9) 1640-1643
  CrossrefPubMedGoogle Scholar
• 5 Loungnarath R, Blanchard H, Saint-Vil D. [Blunt injuries of the pancreas in children]. Ann Chir 2001; 126 (10) 992-995
  CrossrefPubMedGoogle Scholar
• 6 Klin B, Abu-Kishk I, Jeroukhimov I , et al. Blunt pancreatic trauma in children. Surg Today 2011; 41 (7) 946-954
  CrossrefPubMedGoogle Scholar
• 7 Cigdem MK, Senturk S, Onen A, Siga M, Akay H, Otcu S. Nonoperative management of pancreatic injuries in pediatric patients. Surg Today 2011; 41 (5) 655-659
  CrossrefPubMedGoogle Scholar
• 8 Wales PW, Shuckett B, Kim PC. Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children. J Pediatr Surg 2001; 36 (5) 823-827
  CrossrefPubMedGoogle Scholar
• 9 Keller MS, Stafford PW, Vane DW. Conservative management of pancreatic trauma in children. J Trauma 1997; 42 (6) 1097-1100
  CrossrefPubMedGoogle Scholar
• 10 Kouchi K, Tanabe M, Yoshida H , et al. Nonoperative management of blunt pancreatic injury in childhood. J Pediatr Surg 1999; 34 (11) 1736-1739
  CrossrefPubMedGoogle Scholar
• 11 Wood JH, Partrick DA, Bruny JL, Sauaia A, Moulton SL. Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg 2010; 45 (2) 401-406
  CrossrefPubMedGoogle Scholar
• 12 Jobst MA, Canty Sr TG, Lynch FP. Management of pancreatic injury in pediatric blunt abdominal trauma. J Pediatr Surg 1999; 34 (5) 818-823 , discussion 823–824
  CrossrefPubMedGoogle Scholar
• 13 Canty Sr TG, Weinman D. Management of major pancreatic duct injuries in children. J Trauma 2001; 50 (6) 1001-1007
  CrossrefPubMedGoogle Scholar
• 14 Borkon MJ, Morrow SE, Koehler EA , et al. Operative intervention for complete pancreatic transection in children sustaining blunt abdominal trauma: revisiting an organ salvage technique. Am Surg 2011; 77 (5) 612-620
  PubMedGoogle Scholar
• 15 Stringer MD. Pancreatic trauma in children. Br J Surg 2005; 92 (4) 467-470
  CrossrefPubMedGoogle Scholar
• 16 Degiannis E, Levy RD, Potokar T, Lennox H, Rowse A, Saadia R. Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995; 82 (9) 1240-1242
  CrossrefPubMedGoogle Scholar
• 17 Rutkoski JD, Segura BJ, Kane TD. Experience with totally laparoscopic distal pancreatectomy with splenic preservation for pediatric trauma—2 techniques. J Pediatr Surg 2011; 46 (3) 588-593
  CrossrefPubMedGoogle Scholar
• 18 Mukherjee K, Morrow SE, Yang EY. Laparoscopic distal pancreatectomy in children: four cases and review of the literature. J Laparoendosc Adv Surg Tech A 2010; 20 (4) 373-377
  CrossrefPubMedGoogle Scholar
• 19 Gow KW. Laparoscopic distal pancreatectomy for blunt trauma in a 10-year-old child. Am Surg 2010; 76 (11) E199-E200
  PubMedGoogle Scholar
• 20 Nikfarjam M, Rosen M, Ponsky T. Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy. J Pediatr Surg 2009; 44 (2) 455-458
  CrossrefPubMedGoogle Scholar
• 21 Lovvorn III HN, Nance ML, Ferry Jr RJ , et al. Congenital hyperinsulinism and the surgeon: lessons learned over 35 years. J Pediatr Surg 1999; 34 (5) 786-792 , discussion 792–793
  CrossrefPubMedGoogle Scholar
• 22 Al-Shanafey S, Habib Z, AlNassar S. Laparoscopic pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy. J Pediatr Surg 2009; 44 (1) 134-138 , discussion 138
  CrossrefPubMedGoogle Scholar
• 23 Cogbill TH, Moore EE, Morris Jr JA , et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31 (12) 1600-1606
  CrossrefPubMedGoogle Scholar
• 24 Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL. Management of blunt major pancreatic injury. J Trauma 2004; 56 (4) 774-778
  CrossrefPubMedGoogle Scholar