Blunt Trauma Pancreas in Children: Is Non-Operative Management Appropriate for All Grades?

Garg, Ravi; Mahajan, Jai Kumar

doi:10.5223/pghn.2017.20.4.252

Cited by 13 publications

(11 citation statements)

References 25 publications

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“…The most common grades of injury were II and III. This is similar to previous studies in children [5,15]. The proximal body was the most common location of pancreatic injury, accounting for two-thirds of cases.…”

Section: Discussionsupporting

confidence: 91%

“…Depending on the severity and grade of injury, treatment could be conservative, interventional or surgical. Some authors favor conservative management for most grades [5][6][7][8] while others advocate surgical treatment, especially for higher grade injuries, which is shown to reduce complications and hospital stay with a rapid resumption of a normal diet [9,10]. Assessing pancreatic duct status is important in deciding the treatment of pancreatic trauma as it is the main cause for complications [11].…”

Section: Introductionmentioning

confidence: 99%

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CT and MRI findings in pancreatic trauma in children and correlation with outcome

et al. 2020

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Background There are limited published data on pancreatic trauma imaging in children. Objective To present our experience using computed tomography (CT) and magnetic resonance (MR) imaging of pancreatic trauma in children and to correlate the imaging grade of pancreatic injury with management and outcome. Materials and methods A retrospective cohort study of children with pancreatic injury presenting between Jan. 1, 2000, and Dec. 31, 2016, was performed. Patient charts were reviewed to note demographics, the mechanism of injury, associated abdominal injuries, management and outcome. All imaging was rereviewed by two radiologists blinded to clinical and laboratory information, and pancreatic injuries were graded according to the American Association for the Surgery of Trauma (AAST). Results Of 3,265 patients presented as trauma team activations during the study period, only 28 (0.86%) children (19 boys, 9 girls; mean age: 7.14 years; age range: 1-15 years) had pancreatic injury. Of the available 27 CTs of the abdomen, 26 were performed on the day of trauma. Associated injuries were seen in 25/27 children, most frequently in the liver and lung, 16 (59.2%) each. There were 5 (19%) Grade I, 9 (33%) Grade II, 8 (30%) Grade III and 3 (11%) Grade IV. No patients had Grade V injury. No pancreatic parenchymal injury was identified in 2 (7%) patients with isolated fluid around the pancreas and mesentery. The pancreatic duct was visible in all 10 children (days: 0-330, median days: 41 post-trauma) who had MRI. Eight of these children, who had Grade III/IV injuries on CT and confirmed pancreatic duct injury on endoscopic retrograde cholangiopancreatography (ERCP) or surgery, showed either signal intensity difference in pancreatic parenchyma and/or caliber difference in the pancreatic duct proximal and distal to the injury site. Two patients died because of multiorgan injuries, 9 patients (mainly with Grade III and IV injuries) underwent surgery and/or ERCP, and 16 patients were managed conservatively. AAST grading of pancreatic injury on CT correlated with type of management (P=0.0001) with most of the Grade III and IV injuries treated with intervention and/or surgery while all of the Grade I and II injuries were treated conservatively. Conclusion Pancreatic injury is rare in children but often associated with other organ injuries most frequently involving the liver and lung. CT grading of injury correlates with management and guides intervention and/or surgery versus conservative treatment. MRI is useful for assessing pancreatic duct injury by demonstrating the pancreatic duct directly and/or secondary changes like signal intensity difference in pancreatic parenchyma and caliber difference in the pancreatic duct.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

CT and MRI findings in pancreatic trauma in children and correlation with outcome

et al. 2020

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“…A total of 37 studies were included. 1,4,6 -40 There were 34 published journal articles, 2 conference abstracts, and 1 published conference presentation. In 21 of the studies, imaging of PI was the primary objective.…”

Section: Resultsmentioning

confidence: 99%

Imaging of Blunt Pancreatic Trauma: A Systematic Review

2020

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Purpose: Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. Methods: Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. Results: After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. Conclusion: There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.

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“…US is commonly employed as the initial imaging modality in patients of blunt trauma, however, the diagnostic accuracy of pancreatic injuries by US is poor and the grading is usually based on CT scan images [28]. US can show pancreatic enlargement with heterogeneous texture and also retroperitoneal haematoma with fluid collections secondary to pancreatic injuries.…”

Section: Traumamentioning

confidence: 99%

Pediatric ultrasonography of the pancreas: normal and abnormal findings

et al. 2018

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The pancreas is easily investigated in children thanks to the relative lack of fat tissue and the large left hepatic lobe with an optimal acoustic window. The use of high frequency, even linear transducers, usually results in detailed images of all pancreatic areas. A wide spectrum of pancreatic pathologic conditions can be identified and monitored at ultrasound although they are relatively uncommon during childhood compared to the adult. In this paper we briefly review the anatomy, technique, and sonographic aspects of normal and pathological pediatric pancreas. Keywords Pancreas • Children • Ultrasound SommarioLo studio ecografico del pancreas in età pediatrica è molto performante grazie alla scarsa presenza di tessuto adiposo sottocutaneo e all'ipertrofia della piccola ala epatica che fornisce una ottimale finestra acustica. L'utilizzo di sonde ad alta frequenza, spesso con il ricorso a trasduttori lineari, consente di ottenere un buon dettaglio anatomico di tutta la regione pancreatica. Diverse sono le patologie che interessano il pancreas in questa fascia di età e che possono essere identificate e monitorizzate con l'indagine ecografica sebbene siano relativamente poco comuni rispetto all'adulto. In questo articolo descriviamo l'anatomia, la tecnica di indagine e gli aspetti ecografici normali e patologici della ghiandola pancreatica in età pediatrica.

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Blunt Trauma Pancreas in Children: Is Non-Operative Management Appropriate for All Grades?

Cited by 13 publications

References 25 publications

CT and MRI findings in pancreatic trauma in children and correlation with outcome

CT and MRI findings in pancreatic trauma in children and correlation with outcome

Imaging of Blunt Pancreatic Trauma: A Systematic Review

Pediatric ultrasonography of the pancreas: normal and abnormal findings

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