Blunt pancreatic injury in children: Lessons from 11-year experience in a pediatric center

Zhang, Ting; Luo, Wenjuan; Wang, Wenqiao; Long, Qi; Ma, Ming

doi:10.1016/j.asjsur.2023.08.111

Cited by 1 publication

(4 citation statements)

References 24 publications

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“…The WTA Committee defines Grade III of pancreatic injury as an MPD injury to the left of the superior mesenteric vein, and it recommend distal pancreatectomy as the gold standard in adults with this kind of damage. Although most reports in children have shown a relatively low frequency of Grade 3 BPI (10% according to Zang et al [9], and 22.6% according to Gong et al [21]), a recent study by Cattelani et al reported that 17 out of 20 children and 5 out of 10 adults had Grade III pancreatic trauma [4]. As mentioned earlier, children with Grade III pancreatic trauma can be treated non-surgically.…”

Section: Operative Treatment Objectivesmentioning

confidence: 93%

“…The reported sensitivities for the detection of pancreatic injuries by US ranged from 27% to 96% [15]. Zhang et al reported a 68% accuracy rate for detecting pancreatic injury in 51 children by early US (Table 1) [9]. Ultrasound imaging, however, cannot provide valuable information regarding the size, location, and characteristics of BPIs [14].…”

Section: Early Diagnosis-pitfallsmentioning

confidence: 99%

“…In a large series by Zhang et al (51 children with BPI), 46 patients (90.2%) underwent abdominal CT, 31 patients (60.8%) underwent enhanced CT, and 12 patients (23.5%) underwent MRCP. Those authors reported a 77% accuracy rate for CT and a 100% accuracy rate for MRCP in identifying MPD damage [9]. Ibrahim et al recently presented their experience with CT and MRI in pediatric pancreatic trauma and correlated the imaging grade of pancreatic injury with management and outcome.…”

Section: Early Diagnosis-pitfallsmentioning

confidence: 99%

“…In addition, 40% of their patients later developed structural changes, but only one-half were symptomatic. Zhang et al recently reported 51 children with BPI [9], among whom only two underwent surgical procedures, both with drainage with/without debridement. However, 47% of their patients developed pancreatic pseudocysts (75% with high-grade injuries [HGI] and 42% with low-grade injuries [LGI]).…”

Section: Treatment Strategy-non-operative Versus Operative Managementmentioning

confidence: 99%

See 3 more Smart Citations

Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review

Sukhotnik,

Cohen

2024

Children

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Blunt pancreatic injury (BPI) is relatively uncommon in children, and is associated with relatively high morbidity and mortality, especially if diagnosis is delayed. The aim of this report is to review the literature regarding controversial questions in the early diagnosis and management of pediatric BPI. A representative case of blunt pancreatic trauma in a six-year-old girl with delayed diagnosis and intraoperative and postoperative complications was described. A systematic search of databases and the grey literature in Scopus and Web of Science using relevant keywords was conducted. A total of 26 relevant articles published in last 5 years were found in PubMed. Although early CT performance is considered part of initial pancreatic trauma workup, the sensitivity of CT for detecting main pancreatic duct injuries in children is relatively low. MRCP and ERCP (if available) are useful for assessing ductal injury and should be performed when the status of the pancreatic duct is unclear on the CT. Most patients with low-grade pancreatic damage may be treated conservatively. Although surgery involving distal pancreatectomy remains the preferred approach for most children with high-grade pancreatic injury, there is growing evidence to suggest that non-operative management (NOM) is safe and effective. Most pancreatic pseudo cysts following NOM had relatively mild complications, and most resolved spontaneously. For those children who do require surgery, a conservative operative approach with the least risk is advocated. In conclusion, the optimal management for pediatric pancreatic trauma is controversial. Further clinical trials are required to generate clinical practice guidelines on pancreatic trauma in a child population.

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Section: Operative Treatment Objectivesmentioning

confidence: 93%