Efficacy of early endoscopic intervention in pediatric pancreatic duct injury management

Ishikawa, Masatoshi; Shimojima, Naoki; Koyama, Tomohide; Miyaguni, Kazuaki; Tsukizaki, Ayano; Mizuno, Yuki; Hashimoto, Makoto; Ishihama, Hideo; Tomita, Hirofumi; Shimotakahara, Akihiro; Hirobe, Seiichi

doi:10.1007/s00383-021-05003-z

Cited by 8 publications

(14 citation statements)

References 18 publications

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“…[ 11 , 12 ] Although many authors attempted endoscopic stenting to treat pancreatic injury in recent years, it was only for patients with normal or partial damage of the MPD. [ 13 ] For patients with complete injuries of the MPD, surgical options mainly include distal pancreatic resection, proximal pancreatic closure and distal pancreaticojejunostomy Roux-en-Y anastomosis, and Whipple surgery. [ 11 ] However, these operations not only require longer operation time and more intraoperative blood loss but also disrupt normal bowel.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported in the literature that endoscopic treatment for patients with complete rupture of the MPD carries a high risk of complications and mortality. [ 13 ] We attempted for the first time to perform hybrid surgery for grade IV blunt pancreatic trauma, which installed the MPD stent with the assistance of endoscope during operation, and then performed end-to-end anastomosis of the MPD and pancreatic parenchyma. Compared with endoscopic stent therapy, [ 13 ] the surgeon manipulated the guidewire to pass through the distal end of MPD under direct vision in hybrid surgery which can not only reduce the difficulty of catheterization and improve the success rate of catheterization, but also reduce various complications caused by repeated catheterization.…”

Section: Discussionmentioning

confidence: 99%

“…[ 13 ] We attempted for the first time to perform hybrid surgery for grade IV blunt pancreatic trauma, which installed the MPD stent with the assistance of endoscope during operation, and then performed end-to-end anastomosis of the MPD and pancreatic parenchyma. Compared with endoscopic stent therapy, [ 13 ] the surgeon manipulated the guidewire to pass through the distal end of MPD under direct vision in hybrid surgery which can not only reduce the difficulty of catheterization and improve the success rate of catheterization, but also reduce various complications caused by repeated catheterization. Compared with traditional pancreatectomy, [ 12 ] this method can effectively avoid excision of excessive pancreatic tissue, which may lead to internal and external secretion dysfunction.…”

Section: Discussionmentioning

confidence: 99%

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Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Xu,

2024

Medicine

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Introduction: A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a complete disruption of the MPD involved distal pancreatic resection and pancreaticojejunostomy Roux-en-Y anastomosis. Nevertheless, there have been no reported cases of hybrid surgery being employed for the complete disruption of the MPD. Patient concerns: A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck. Diagnoses: Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV. Interventions: The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct. Outcomes: The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction. Lessons: The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Xu,

2024

Medicine

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“…Traumatic pancreatic injuries are relatively rare in children because the pancreas is anatomically fixed at the retroperitoneal location, and they account for approximately 0.3%-0.7% of all pediatric trauma cases[ 1 - 3 ] and 3%-12% of children with blunt abdominal trauma[ 4 ]. Most traumatic pancreatic injuries in boys are related to bicycle handlebars[ 2 ].…”

Section: Discussionmentioning

confidence: 99%

Traumatic pancreatic ductal injury treated by endoscopic stenting in a 9-year-old boy: A case report

Kwon¹,

Jung²,

Park³

2023

World J Clin Cases

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BACKGROUND Traumatic pancreatic injury is relatively rare in children, accounting for approximately 3%-12% of blunt abdominal trauma cases. Most traumatic pancreatic injuries in boys are related to bicycle handlebars. Traumatic pancreatic injuries often result in delayed presentation and treatment, leading to high morbidity and mortality. The management of children with traumatic main pancreatic duct injuries is still under debate. CASE SUMMARY We report the case of a 9-year-old boy who was presented at our institution with epigastric pain after being stuck with his bicycle handlebar at the upper abdomen and then treated with endoscopic stenting because of a pancreatic ductal injury. CONCLUSION We believe that endoscopic stenting of pancreatic ductal injuries may be a feasible technique in certain cases of children with traumatic pancreatic duct injuries to avoid unnecessary operations.

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“…Endoscopic retrograde cholangiopancreatography (ERCP) is frequently employed in adult patients with chronic pancreatitis to manage pancreatic duct disease including strictures or obstructing stones. Pediatric expertise with ERCP has historically trailed that of adult gastroenterologists but access for children continues to improve, and studies repeatedly demonstrate safety and efficacy in this population [3,4,5,6 ▪ ]. Small procedural volume at single centers has limited necessary research in pediatric ERCP, but recent multicenter efforts including the creation of the Pediatric ERCP Database Initiative (PEDI) have sought to address this problem.…”

Section: Specific Therapiesmentioning

confidence: 99%

Endotherapy in pediatric pancreatitis

Norris

Troendle

2023

Current Opinion in Gastroenterology

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Purpose of review Some children with acute recurrent and chronic pancreatitis stand to benefit from therapeutic endoscopic interventions. The purpose of this review is to summarize specific endoscopic therapies used for these conditions and highlight areas of future research. Recent findings Multicenter collaboration and consortium efforts have provided more data now than ever on the technical outcomes and safety of therapeutic endoscopic procedures for pancreatitis in children. Indications are growing but more research is needed to help guide patient selection. Summary Advanced endoscopic procedures including endoscopic retrograde cholangiopancreatography, endoscopic-ultrasound guided therapies, and single-operator pancreatoscopy may be used in patients with acute recurrent or chronic pancreatitis to manage pancreatic duct obstruction or local complications including pseudocysts and walled-off necrosis. Patient and procedural factors differ between adults and children. Access to these procedures for younger children is growing, and technical outcomes and adverse event rates appear similar between adults and children.

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Efficacy of early endoscopic intervention in pediatric pancreatic duct injury management

Cited by 8 publications

References 18 publications

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Traumatic pancreatic ductal injury treated by endoscopic stenting in a 9-year-old boy: A case report

Endotherapy in pediatric pancreatitis

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