Elsevier

Journal of Pediatric Surgery

Volume 43, Issue 9, September 2008, Pages 1640-1643
Journal of Pediatric Surgery

Original article
Pancreatic injury in children: good outcome of nonoperative treatment

https://doi.org/10.1016/j.jpedsurg.2008.03.061Get rights and content

Abstract

Purpose

Treatment of blunt injury of the pancreas in children remains controversial. Some prefer nonoperative treatment, whereas others prefer operative management in selected cases. This report reviews the treatment of patients with blunt pancreatic trauma admitted to a level I pediatric trauma center in The Netherlands.

Methods

Medical records of all children less than 15 years with blunt pancreatic trauma admitted to the University Medical Center St Radboud in the period 1975 to 2003 were retrospectively analyzed.

Results

Thirty-four children were included, age 3 to 14 years. Most injuries were because of bicycle accidents (58%). On admission, amylase was raised in 90% of the patients. Five patients had pancreatic duct injuries identified by imaging (endoscopic retrograde cholangiopancreaticography was used once, magnetic resonance cholangiopancreaticography twice) or at surgery. Thirty-one children were initially managed nonoperatively. Pancreatic surgery was performed in 3 children (1 Roux-Y, 2 drainage only). Mean hospital stay was 29 days in the operative group and 24 days in the nonoperative group. Fluid collections developed in 2 operated patients. Both resolved spontaneously. In 14 of the 31 nonoperated patients, a pseudocyst developed. Only 6 of these needed secondary intervention. Of these, 3 were drained percutaneously. There was no mortality and no long-term morbidity in both groups.

Conclusions

Nonoperative management of pancreatic injury in children has good clinical outcome. Only 10% need secondary surgery. In 50%, pseudocysts develop of which half can be managed nonoperatively. The reliability of computed tomographic scan grading is of limited value to decide whether to operate primarily. There is little to gain with ERCP and stenting. The place of MRCP as a noninvasive diagnostic tool remains to be determined.

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

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Presented at the 38th Annual Meeting of the American Pediatric Surgical Association, Orlando, Florida, May 24-27, 2007.

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