Operative versus non-operative management of blunt pancreatic trauma in children: Systematic review and meta-analysis

Kopljar, Mario; Ivandić, Stjepan; Mesić, Marko; Bakota, Bore; Žiger, Tihomil; Kondža, Goran; Pavić, Roman; Milošević, Milan; Čoklo, Miran

doi:10.1016/j.injury.2020.02.035

Cited by 14 publications

(30 citation statements)

References 46 publications

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“…In a systematic review and meta-analysis of pancreatic trauma occurring in children, most patients could initially be managed conservatively. In addition, ERCP was found to offer high diagnostic accuracy and to facilitate the repair of ductal injuries[ 23 ] in both children and adults[ 24 ].…”

Section: Indications and Options For Surgical Managementmentioning

confidence: 99%

Indications for the surgical management of pancreatic trauma: An update

Pavlidis¹,

Psarras²,

Symeonidis³

et al. 2022

WJGS

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Pancreatic trauma is rare compared to other abdominal solid organ injuries, accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade III to grade V injuries.

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Section: Indications and Options For Surgical Managementmentioning

confidence: 99%

Indications for the surgical management of pancreatic trauma: An update

Pavlidis¹,

Psarras²,

Symeonidis³

et al. 2022

WJGS

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“…Pancreatic trauma in children, although uncommon, is a serious condition associated with high morbidity [ 1 , 2 ]. Blunt pancreatic trauma is more common than penetrating injuries, though remains rare.…”

Section: Introductionmentioning

confidence: 99%

“…Blunt pancreatic trauma is more common than penetrating injuries, though remains rare. The incidence of traumatic pancreatic injuries in children with blunt abdominal trauma is less than 10%, with the pancreas being the fourth most commonly injured solid organ after the spleen, liver, and kidneys [ 2 ]. The most frequent aetiologies include motor vehicle accidents, followed by domestic violence and bicycle accidents [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…Serum amylase and lipase are elevated in the majority of patients with pancreatic trauma. However, they may be normal in the first few hours of trauma [ 1 , 2 ]. Serial tests may thus be appropriate.…”

Section: Introductionmentioning

confidence: 99%

“…Serial tests may thus be appropriate. Serum lipase is considered more specific for pancreatic injury, but neither test is diagnostic [ 2 ]. Positive results should prompt cross-sectional imaging [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Paediatric pancreatic trauma in North Queensland: a 10-year retrospective review

et al. 2023

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Purpose To establish the incidence of pancreatic trauma in North Queensland to the region’s only tertiary paediatric referral centre, and to determine the patient’s outcomes based on their management. Methods A single centre, retrospective cohort study of patients < 18 years with pancreatic trauma from 2009 to 2020 was performed. There were no exclusion criteria. Results Between 2009 and 2020 there were 145 intra-abdominal trauma cases, 37% from motor vehicle accidents (MVA), 18.6% motorbike or quadbike, and 12.4% bicycle or scooter accidents. There were 19 cases of pancreatic trauma (13%), all from blunt trauma and with associated injuries. There were 5 AAST grade I, 3 grade II, 3 grade III, 3 grade IV injuries, and 4 with traumatic pancreatitis. Twelve patients were managed conservatively, 2 were managed operatively for another reason, and 5 were managed operatively for the pancreatic injury. Only 1 patient with a high grade AAST injury was successfully managed non-operatively. Complications included pancreatic pseudocyst (n = 4/19; 3 post-op), pancreatitis (n = 2/19; 1 post op), and post-operative pancreatic fistula (POPF) (n = 1/19). Conclusion Due to North Queensland’s geography, diagnosis and management of traumatic pancreatic injury is often delayed. Pancreatic injuries requiring surgery are at high risk for complications, prolonged length of stay, and further interventions.

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