Experience in the treatment of isolated posttraumatic pancreatic injury complicated by the formation of pseudocysts in a 9-year-old child

Abstract

Over the past decades, the number of cases of traumatic injury to the pancreas in children has increased by 12%, which is associated not only with an increase in car accidents, but also with the popularization of outdoor sports (bicycle, scooter).A 9-year-old boy was hospitalized in the Children's City Clinical Hospital, who was injured as a result of a fall from a bicycle. Upon admission, the child complained of pain in the upper abdomen and in the area of the wound on the anterior abdominal wall.At the time of examination, the condition was severe, the victim was conscious, the abdomen was not swollen, soft, painful on palpation in the upper sections, peritoneal symptoms were negative.According to the ultrasound examination of the abdominal organs, there were signs of pancreatic injury with the formation of a hematoma up to 58 ml. In the general blood test, leukocytosis (12.75x109/l), an increase in amylase up to 1664 U/l. After preoperative preparation, diagnostic laparoscopy was performed with opening and drainage of the omental sac, sanitation and drainage of the abdominal cavity. Upon completion of the operation, the patient continued with antibacterial, hemostatic, infusion therapy, administered pancreatic secretion inhibitors, and was prescribed dietary nutrition. In the dynamics of ultrasound examination, a pseudocyst of the body of the pancreas with a volume of up to 22 ml was noted. In the course of treatment, the condition stabilized, the amylase indices decreased (271 U/l), the child was discharged home on 44 days a day. After 4.5 months. the volume of the cyst increased to 320 ml, and therefore, during planned hospitalization, a laparotomy was performed with the imposition of pancreatocystojejunoanastomosis on the Roux-enabled loop. The postoperative period was uneventful, the child was discharged home on the 14th day.Conclusion. During laparoscopy, the diagnosis was clarified, the omental sac and abdominal cavity were sanitized, followed by drainage. Constant monitoring of the ultrasound picture of the pancreatoduodenal zone and the dynamics of amylase indicators made it possible to identify and evaluate post-traumatic changes in the pancreas in dynamics. An increase in the volume of the pseudocyst served as an indication for the imposition of pancreatocystojejunoanastomosis on the Roux-en-Y loop.