Original articlePancreatic injury in children: good outcome of nonoperative treatment☆
Section snippets
Materials and methods
A retrospective case review analysis was conducted from January 1975 to August 2003 of all children less than 15 years admitted at University Medical Center St Radboud, Nijmegen. The Radboud University Hospital is 1 of the 4 major pediatric surgical centers in the Netherlands and a level I pediatric trauma center. The pediatric surgical unit in Nijmegen acts as a tertiary referral service. Five pediatric surgeons work at the unit and are all involved in the treatment of patients with pancreatic
Results
Thirty-four children in the age of 3 to 14 years sustained pancreatic injury secondary to blunt abdominal trauma (Table 1). The mean age was 8 years. There were 24 boys and 10 girls. Mechanism of injury was bicycle injuries in 18 (53%), motor vehicle accidents in 7 (21%), a horseshoe kick in 2 (6%), and other injuries in 7 (21%).
Twenty patients were primarily presented to our ED. The mean time from accident to presentation on the ER was 4 hours (0-50 hours). The remaining 14 patients were
Discussion
The management of blunt pancreatic trauma in children remains controversial. It is generally accepted that in grade 1 and 2 injury, nonoperative management is first choice of treatment. The controversy of operative and nonoperative treatment is focused on grade 3 and 4 injury [1], [2], [5], [6], [8]. The retrospective analysis of our data supports the choice for nonoperative treatment because we saw no mortality and nil residual morbidity. The most important complication after blunt pancreatic
References (21)
- et al.
Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes
J Pediatr Surg
(2007) - et al.
Nonoperative management of pancreatic injuries in children
J Pediatr Surg
(1998) - et al.
Pancreatic trauma in children
J Pediatr Surg
(2004) - et al.
Nonoperative management of blunt pancreatic injury in childhood
J Pediatr Surg
(1999) - et al.
Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children
J Pediatr Surg
(2001) - et al.
Early operation in children with pancreas transection
J Pediatr Surg
(2001) - et al.
Laparoscopic distal pancreatectomy for traumatic pancreatic transection
J Pediatr Surg
(2003) - et al.
Surgical management of the pancreatic pseudocyst in children: a long-term evaluation
J Pediatr Surg
(1995) - et al.
Treatment of pancreatic duct disruption in children by an endoscopically placed stent
J Pediatr Surg
(2001) - et al.
Nonoperative treatment of traumatic pancreatic duct disruption in children with an endoscopically placed stent
J Pediatr Surg
(2005)
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Endoscopic Retrograde Cholangiopancreatography
2020, Pediatric Gastrointestinal and Liver Disease, Sixth EditionChildhood pancreatic trauma: Clinical presentation, natural history and outcome
2020, PancreatologyCitation Excerpt :In a multicenter study comprising of 86 children with ductal injury from 20 trauma centers, organized fluid collection was seen in 42/71 (59%) of which 26/42 (62%) required some form of intervention which is similar to our observation [20]. Blaauw and colleagues showed that 16/34 (47%) develop pseudocyst of which 8/16 (50%) required drainage at various time points [14]. In patients (both adults and children) with pancreatic fluid collections of varied etiology, those with disconnected pancreatic duct syndrome were more difficult to treat and required more hybrid treatment modalities, endoscopic re-interventions, rescue surgery and longer hospital stay [21].
Non-operative management of pancreatic injury
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :A recent review of that National Trauma Data Bank found that approximately half of pediatric pancreatic injuries in the United States are managed nonoperatively, with equivalent or superior outcomes to operative intervention [3,4]. Many series in the literature report successful non-operative management of pediatric patients with severe pancreatic injuries with no increase in mortality [1,4–10]. Non-operative management consists of nasogastric tube (NGT) decompression and total parenteral nutrition (TPN) for an average of 14 days [1], as well as somatostatin analogs [1].
Three cases of paediatric pancreatic injury involving the main pancreatic duct
2019, Trauma Case ReportsModified Whipple on an 18-month-old with traumatic pancreatic transection and duodenal rupture
2019, Trauma Case Reports
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Presented at the 38th Annual Meeting of the American Pediatric Surgical Association, Orlando, Florida, May 24-27, 2007.