Papers From the 2nd Western Pediatric Trauma Conference
Role of ERCP in pediatric blunt abdominal trauma: A case series at a level one pediatric trauma center

https://doi.org/10.1016/j.jpedsurg.2014.08.017Get rights and content

Abstract

Background

There is no consensus regarding the appropriate use of endoscopic retrograde cholangiopancreatography (ERCP) in pediatric trauma. We report our experience with ERCP for management of pediatric pancreatic and biliary injury following blunt abdominal trauma.

Methods

A retrospective chart review was performed for pediatric patients with blunt abdominal trauma from July 2008 through December 2012 at our pediatric trauma center. For patients who underwent ERCP, demographics, injury characteristics, diagnostic details, procedures performed, length of stay, total parenteral nutrition use, and complications were reviewed.

Results

There were 532 patients identified: 115 hepatic injuries, 25 pancreatic injuries and one gall bladder injury. Nine patients (mean age 7.8 years) underwent ERCP. Seven (78%) had pancreatic injuries, while two (22%) had bilateral hepatic duct injuries. The median time to diagnosis was one day (range, 0-12). Diagnostic ERCP only was performed in three patients, two of which proceeded to distal pancreatectomy. Five patients had stents placed (two biliary and three pancreatic) and four sphincterotomies were performed. Despite pancreatic stenting, one patient required distal pancreatectomy for persistent leak. Median length of stay was 11 days.

Conclusions

Pediatric pancreatic and biliary ductal injuries following blunt abdominal trauma are uncommon. ERCP can safely provide definitive treatment for some patients.

Section snippets

Methods

Approval from the Phoenix Children’s Hospital Institutional Review Board was obtained. A prospectively maintained trauma database was used to identify all patients (≤ 21 years) admitted to Phoenix Children’s Hospital with a diagnosis of blunt abdominal trauma from July 1, 2008 to December 31, 2012. A retrospective chart review was performed for all patients who underwent ERCP. Patient demographics, injury characteristics, diagnostic details, procedures performed, length of stay (LOS), total

Results

During the 4.5 year study period, there were 532 patients with a diagnosis of blunt abdominal trauma including 115 hepatic injuries (21.6%), 25 pancreatic injuries (4.7%) and one gallbladder injury (0.19%). The mean age was 9 years (range, 2 months to 19 years).

Nine patients underwent ERCP (1.7%). The mean age was 7.8 years (range, 17 months to 15 years). Five patients (55.6%) were male. The mean weight was 26.4 kg (range, 9.96 to 50.3 kg). The majority of patients, 5/9 (55.6%), had handlebar-related

Discussion

Pancreatic injury is uncommon secondary to the retroperitoneal location of the pancreas, and the diagnosis of pancreatic injury is frequently delayed due to limitations of standard imaging modalities.[12], [13] ERCP is considered the most accurate method to diagnose pancreatic duct disruption and has the added benefit of identifying the exact location and extent of the injury.[13], [14] Treatment for pancreatic ductal injury, however, remains controversial. Recently, operative management has

Conclusion

Selected pancreatic injuries resulting from blunt abdominal trauma may be managed with ERCP, but a moderate rate of failure is expected. Major blunt pediatric bile duct injuries appear to be extremely rare and can be difficult to diagnose. ERCP for diagnosis, definitive therapy, or as a method to avoid laparotomy may be beneficial in some cases and should be considered for evaluation of grade III or higher pancreatic injuries. ERCP in the pediatric population is safe, and may serve as an

Summary statement

The experience with ERCP in the diagnosis or management of blunt abdominal trauma in the pediatric literature is sparse. ERCP can be used safely in the pediatric population and can be valuable as both diagnostic and therapeutic for pancreatic and bile duct injuries following blunt abdominal trauma.

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Presented at Western Pediatric Trauma Conference July 9–11, 2014.

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