Nonoperative management of pancreatic injuries in pediatric patients

Abstract

The majority of the pancreatic injuries in pediatric patients can be successfully treated conservatively, unless there is hemodynamic instability and a hollow viscus injury. The most common complication is a pseudocyst.

Camel-related pancreatico-duodenal injuries: A report of three cases and review of literature

“…The progressive increase of serum amylase, as occurred in the third patient, should be taken seriously and pancreatic injury should be suspected 3,22 . Non operative management of pediatric pancreatic injuries is recommended having a success rate of more than 80% 24 . We have treated our second adult patient conservatively.…”

Paediatric pancreatic trauma: A review of the literature and results of a multicentre survey on patient management:

“…This is weaned when abdominal pain resolves, amylase returns to normal levels and appetite returns. [1,5,20,21] As can be seen in the results section from this survey, the majority of conservatively treated patients would have their parenteral nutrition stopped on resolution of pain.…”

“…This has been shown to be a safe approach to managing paediatric pancreatic trauma patients. [1,5,6,20,21] It is accepted that there will be a higher incidence of pseudocyst formation, but proponents of this technique do not consider pseudocyst formation a complication. According to the latest Atlanta Classification for pancreatitis, a fluid collection around the pancreas in the first 4 weeks post injury is called an acute peripancreatic fluid collection.…”

“…[12,21] Those that persist and form pseudocysts that remain symptomatic, require some sort of definitive intervention. Cigdem et al [20] treated 25 paediatric pancreatic trauma patients conservatively; 11 pseudocysts developed, 5 resolved spontaneously and 6 required surgical intervention to drain the cyst. De Blaauw et al [21] treated 31 patients conservatively, with 6 having a grade III or IV injury; 14 developed pseudocysts but only 6 needed operative drainage.…”

Stumpe pancreasskader hos barn

“…In the 13 studies included here (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)29), the number and type of pancreatic injury varied, and all studies with more than 100 patients were from the USA ( Table 2). A Cochrane study from 2014 points to deficiencies in the current data on the choice of treatment (6).…”