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

Abbo, Olivier; Lemandat, Aurélie; Reina, Nicolas; Bouali, O.; Ballouhey, Quentin; Carfagna, L.; Lemasson, F.; Harper, Luke; Sauvat, Frédérique; Galinier, P.

doi:10.1055/s-0033-1333642

Cited by 16 publications

(8 citation statements)

References 24 publications

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“…In a study, 45% of the traumatic pancreatic pseudocyst required surgical intervention in comparison to 92% of the nontraumatic pancreatic pseudocyst patients [ 24 ]. Despite formation of pseudocysts, conservative management has been thought to be the best option by many authors as the subsequent drainage of a pseudocyst is less radical compared to the laparotomies in acutely injured state [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

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

Garg

Mahajan

2017

Pediatr Gastroenterol Hepatol Nutr

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Purpose: Blunt trauma of pancreas in children is uncommon and its management varies from observational to early operative intervention. We analysed the feasibility and outcome of non-operative management in all grades of paediatric pancreatic injuries. Methods: A total of 15 patients of pancreatic trauma seen in a Paediatric Surgery Unit were retrospectively analyzed. Results: Age of the patients ranged from 3-11 years (mean, 7.7 years). The mode of injury was local trauma in 9 children. Only 3 patients had associated injuries and all were haemodynamically stable. Serum amylase levels were raised in 12 patients at admission which ranged from 400-1,000 IU. Computed tomography scan made a correct diagnosis in 14 patients. Grades of the injury varied from grade I-V (1, 3, 6, 4, 1 patients respectively). Fourteen patients were managed conservatively. One patient underwent laparotomy for suspected superior mesenteric hematoma. The average duration of enteral feeds was 3.7 days and of hospital stay was 9.4 days. Six patients formed pancreatic pseudocysts; two were managed conservatively while the other four underwent cystogastrostomy. The patients were followed up for a period of 1-12 years. All remained asymptomatic and none had exocrine or endocrine deficiencies. Conclusion: Non-operative treatment for isolated blunt trauma of pancreas in children may be safely followed for all the grades of injury; if associated injuries requiring surgical intervention are ruled out with a good quality imaging and the patients are hemodynamically stable. It did not increase the hospital stay and morbidity and avoided operative intervention on acutely injured pancreas.

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Section: Discussionmentioning

confidence: 99%

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

Garg

Mahajan

2017

Pediatr Gastroenterol Hepatol Nutr

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“…Pseudocyst is the most frequent complication following NOM [15, 52, 53, 64, 68, 69, 72, 154, 257, 258]. CT-scan is useful in evaluating pseudocysts and peripancreatic fluid collections following PI [96, 247, 259, 260] and in guiding percutaneous drainage [40].…”

Section: Methodsmentioning

confidence: 99%

“…Although transient post-operative glucose intolerance is common in all critically ill trauma patients, the incidence of persistent new-onset endocrine dysfunction after traumatic distal pancreatectomy is very low (< 4%) [263]; insulin requirement is more frequently associated to proximal pancreatic resections [72, 263] or Whipple procedure [264]. However, both exocrine and endocrine insufficiencies are very rare [4, 10, 15, 16, 45, 52, 54, 58, 69, 265] and no sufficient data exist to have definitive answers and indications [15, 68, 257]. Post-traumatic exocrine or endocrine function in the very long-term seems to be related to overall age and time from injury rather than the surgical treatment [68, 69].…”

Section: Methodsmentioning

confidence: 99%

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

et al. 2019

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Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

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“…The majority of recent papers discuss endoscopically placed stent-cystogastrostomy, transampullary transductal drainage or percutaneous drainage in the radiology suite. [8,9,28] It would seem more logical to do an internal drainage technique if a true ductal injury is present, owing to the higher failure rate of percutaneous drainage. If these techniques do not resolve the pseudocyst, or if recurrence occurs, a more invasive open cystogastrostomy or Roux-en-Y is indicated.…”

Section: Fig 1 Scenario A: Axial Computed Tomography Abdomen With Imentioning

confidence: 99%

Paediatric pancreatic trauma: A review of the literature and results of a multicentre survey on patient management:

Westgarth-Taylor

Loveland

2014

S Afr Med J

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

Cited by 16 publications

References 24 publications

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

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

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Paediatric pancreatic trauma: A review of the literature and results of a multicentre survey on patient management:

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