Management of pancreatic and duodenal injuries in pediatric patients

Abstract

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.

Pancreatic trauma in children

“…4,6 Computerized tomography (CT) currently is the imaging of choice, 3 although there are increasing reports of use of endoscopic retrograde cholangio-pancreatography (ERCP) for both diagnostic and therapeutic management of pancreatic trauma in children. [7][8][9][10] We conducted a retrospective study of the Children's Hospital Westmead (CHW) admissions and the New South Wales Paediatric Trauma Death Registry (State Registry). The aim was to identify the etiology, investigation, and management practices of children with pancreatic trauma while documenting the spectrum of associated injuries and outcomes.…”

Pancreatic Lesions in Children: Our Experience in the Surgical Ward

“…4 Serum amylase and lipase determinations may support clinical suspicion in the diagnosis of pediatric pancreatic trauma but are not reliable or cost-effective as screening tools. 22 CT scan remains the main diagnostic modality used in pediatric blunt abdominal trauma.…”

“…Unfortunately, CT scan may not be conclusive in showing the presence or extent of pancreatic injury. 3,4 Therefore, in otherwise stable patients with suspected pancreatic ductal injury on initial CT scan, prompt ERCP is recommended. 3 Arkowitz et al 22 have proposed a useful classification system for pancreatic trauma.…”

Traumatic rupture of a choledochal cyst masking as a duodenal hematoma

“…Following blunt abdominal trauma, the duodenum is the fourth most commonly injured intra-abdominal organ, occurring in 2-10% of children [4,5]. CT scan is the radiographic examination of choice for hemodynamically stable pediatric patients with blunt abdominal trauma [4,6].…”