Surgical Management of Major Pancreatic Injury in Children

Abstract

Our results support the view that early operation is important in ductal pancreatic injury. We recommend transferring children with a suspected ductal injury to a tertiary center with experience in both pediatric ERCP and pancreatic surgery.

Operative vs nonoperative management of blunt pancreatic trauma in children

“…There were 29 boys (66%) and 15 girls with an average age of 7.3 ± 4.2 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) years. The most common mechanisms of injury were motor vehicle collision (n = 12; 27%), bicycle accidents (n = 11; 25%), and nonaccidental trauma (n = 6; 14%).…”

“…Arguments for either operative or nonoperative approaches to pancreatic injury are often made from analysis of a very small number of patients. One author reports managing fewer than one case of pancreatic trauma per year for a 10-year period [8], and this experience is not exceptional [9][10][11]. The largest single-institution experience report of pancreatic trauma in children included 56 children admitted between 1984 and 1997 [12].…”

EPC/HPSG evidence-based guidelines for the management of pediatric pancreatitis

“…Pancreatic duct dissection, if present may require further endoscopic intervention (i.e. stent placement) or surgical approaches 136,137 . Abdominal pain is a common complaint in children with CP, affecting ~80% children and leading to missed school days and increased health care costs 27,129,138 .…”

Experience with totally laparoscopic distal pancreatectomy with splenic preservation for pediatric trauma—2 techniques

“…Unlike adult victims who are prone to polytrauma from motor vehicle accidents or penetrating events that mandate exploration, children more frequently sustain seemingly minor blunt abdominal trauma [2,3,7]. Most commonly, children are impaled by bicycle, dirt bike, and all-terrain vehicle handlebars that tend to crush the pancreas against the underlying spinal column creating a fracture at the junction of the pancreatic neck and body [2,11,14,15]. Relatively, vague complaints follow for a period before presentation, often 48 to 72 hours after injury because of the persistence of abdominal pain.…”

“…Ranging between 24 and 72 hours, the term early lacks a consistent definition in the literature. Nonetheless, the benefit of such management has been evidenced in a recent multicenter review and another international study [14,18].…”