Papers From the 2nd Western Pediatric Trauma ConferenceRole of ERCP in pediatric blunt abdominal trauma: A case series at a level one pediatric trauma center☆
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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Cited by (35)
Operative versus non-operative management of blunt pancreatic trauma in children: Systematic review and meta-analysis
2021, InjuryCitation Excerpt :Pancreatic trauma, although infrequent, can be associated with major mortality and morbidity including hemorrhage, abscesses, fistulae, pancreatic leaks and pancreatitis [1]. Reported incidence of pancreatic injuries in children admitted for blunt abdominal trauma is less than 10% [2–4]. Pancreas is the fourth most commonly injured solid organ following the spleen, liver and kidneys [5].
Endoscopic ultrasound-guided pancreatic drainage for treating a traumatic main pancreatic duct injury in a child
2021, Journal of Pediatric Surgery Case ReportsCitation Excerpt :In adults with MPD injury, early ERCP and trans-papillary stent insertion are recommended to enhance symptom resolution and healing [7]. The usefulness of ERCP has also been reported in children [8]. However, because endoscopic trans-papillary MPD stent insertion can be challenging both technically and anatomically, EUS-PD should be considered actively as an option, although it is still subject to ongoing research and development.
Role of interventional radiology in the management of complex pediatric surgical cases
2021, International Journal of Surgery Case ReportsCitation Excerpt :Vascularity of the entire right lobe was compromised and transection of the right posterior sectoral duct resulted in high-output bilious drainage from the abdominal drain. In refractory high-output biliary leaks, conventional treatment options include ERCP with stenting or direct operative ductal repair/clipping [11]. However, both the procedures were not ideal for this child.
Clinical course and pancreas parenchyma sparing surgical treatment of severe pancreatic trauma
2020, InjuryCitation Excerpt :Finally, it should be duly noted that conservative treatment can be safe and sufficient to treat ductal injuries of grade III/IV PT [56,57], as in selected cases within our own full PT-cohort. To this end, an experienced endoscopy department is vital [58–60]. On the other hand, conservative and endoscopic management might be associated with higher morbidity and mortality as compared with upfront pancreatic surgery, especially if delaying surgical care [19,61–64].
Distal pancreatectomy for blunt pancreatic transection
2018, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Studies have shown successful management of traumatic pancreatic injury with stenting, especially in low grade injury or upon late presentation [9,10]. Published case series have reported successful management of high-grade pancreatic injury with endoscopic stenting in pediatric patients, albeit with minor complications and a wide range of time from injury [11,12]. This case demonstrates a failed attempt to place a PD stent via ERCP prior to advancing to surgery.
The utility of ERCP in pediatric pancreatic trauma
2018, Journal of Pediatric Surgery
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Presented at Western Pediatric Trauma Conference July 9–11, 2014.