Use of ERCP to identify the site of traumatic injuries of the main pancreatic duct in children

Hall, Richard; Lavelle, M.I.; Venables, C W

doi:10.1002/bjs.1800730533

Cited by 66 publications

(34 citation statements)

References 10 publications

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“…It is now possible and as a result of advancements in pediatric duodenoscopes to perform ERCP in infants. In fact and as a result of this the indications for ERCP in the pediatric age group have been extended to include the investigation and treatment of a variety of biliary and pancreatic diseases including biliary atresia, choledochal cyst, pancreatitis, traumatic pancreatico-biliary ducts disruption and post liver transplant bile leak [7,[21][22][23][24]. Nine of our patients had pancreatitis and two of our patients had posttraumatic bile leak.…”

Section: Discussionmentioning

confidence: 98%

Diagnostic and therapeutic ERCP in the pediatric age group

2006

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The role and value of endoscopic retrograde cholangiopancreatography (ERCP) in the pediatric age group is not well established, because pancreatic and biliary diseases are less common in children. This however is not the case in areas like the Eastern Province of Saudi Arabia where sickle cell disease (SCD) and other hemoglobinopathies are common, with increased frequency of cholelithiasis and choledocholithiasis. The purpose of this study was to evaluate the indications, findings, safety and therapies of ERCP in children. One hundred and twenty five children had diagnostic and/or therapeutic ERCP as part of their management at our hospital. Their medical records were reviewed for: age at diagnosis, sex, Hb electrophoresis, indication for ERCP, findings, therapy and complications. There were 77 males and 48 females. Their age at presentation ranged from 5-18 year (mean 13.25 year). The majority of them had sickle cell disease (77.6%). The indications for ERCP were: obstructive jaundice (67.2%), recurrent biliary colic with or without jaundice (10.4%), acute and chronic pancreatitis (7.2%), postoperative bile leak (2.4%), cholangitis with obstructive jaundice (2.4%), hepatitis of unknown etiology (3.2%), cirrhosis of unknown etiology (4%), thalassemia with jaundice (0.8%), hemobilia (0.8%), acute cholecystitis with jaundice (0.8%), and sickle cell disease with ulcerative colitis and obstructive jaundice (0.8%). In six children, ERCP was done following laparoscopic cholecystectomy. ERCP was carried out under sedation in 91 (72.8%) children and under general anesthesia in 34. It was successful in 121 (96.8%) children while cannulation of the Ampulla failed in four. ERCP was normal in 43 children, but eight of them showed evidence of recent stone passage and in six, there were gallstones. In the remaining children, ERCP revealed: normal CBD with stones (18 patients), dilated CBD with stones (17 patients), dilated CBD without stones (19 patients), dilated biliary tree with stones (10 patients), dilated biliary tree without stones (six patients), bile leak (two patients), dilated biliary tree with stones and choledocho-duodenal fistula (one patient), choledochal cyst (two patients), septate gallbladder (one patient), normal ERCP with multiple pancreatic cysts (one patient) and biliary stricture (one patient). The following procedures were carried out: 35 had endoscopic sphincterotomy and stone extraction, 20 had endoscopic sphincterotomy, four had CBD stenting, one underwent removal of a stent, two had insertion of a nasobiliary tube and one had biliary endoprosethesis. There was no mortality. One had bleeding from the site of sphincterotomy which stopped after adrenaline injection. Four patients (3.2%) developed transient mild pancreatitis which settled conservatively. ERCP in the pediatric age group is safe both as a diagnostic and therapeutic procedure. ERCP can provide valuable information which aid in the diagnosis of biliary and pancreatic diseases in children as well as therapy with the technical feasibility of ...

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Section: Discussionmentioning

confidence: 98%

Diagnostic and therapeutic ERCP in the pediatric age group

2006

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“…Acontrast-enhanced CT scan provides the best assessment of abdominal injuries after major trauma, but injury to the main pancreatic duct may be overlooked (24)(25)(26). Pancreatic duct injuries areless likely to be missed if thin slice CT images areacquired and if the scan is performed within 12 to 24 hours of injury (27,28).…”

Section: Discussionmentioning

confidence: 99%

Pancreatic Injuries in the United Arab Emirates

et al. 2008

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Purpose: to study the mechanism, management and outcome of patients who had sustained pancreatic trauma.Methodology: Patients who were treated for pancreatic trauma in al-ain hospital between October 2002 and august 2007 were retrospectively studied.Results: all eleven patients were males having amedian age of 30 years (range 24-52 years). nine had blunt trauma while two had suffered penetrating injury.t hree presented with shock. associated injuries were present in nine patients (head, chest, and extremities) while seven had other intra-abdominal injuries. Only one patient had isolated pancreatic injury.early serum amylase was elevated in six patients. ct abdomen was diagnostic for pancreatic injury in seven patients. twocases were missed by early ct scan (sensitivity of 78%) while the remaining two patients were taken immediately to the operating theater.all patients underwent laparotomy.Five patients were treated by drainage alone, four had distal pancreatectomy,a bdominal packing was performed in one patient and in another gastrocystostomy was carried out. Pancreatic fistula occurred in three patients. median hospital stay was 25 days (range 12-152 days). two patients (18%) died.Conclusions: blunt trauma is the main cause of pancreatic injury in our country.early ct scan may miss pancreatic injury in almost aq uarter of the patients. thin sliced ct scan, with special views in adedicated abdominal pancreatic study,isrecommended. a high index of clinical suspicion, depending on the mechanism of injury,isimportant for diagnosis of pancreatic injury.mortality is mainly attributable to other associated injuries so simple procedures should initially be adopted for pancreatic injury,especially in haemodynamically unstable patients.

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“…Recently the indications for ERCP in children have been extended to include the investigations of a variety of clinical conditions, including biliary atresia, 20 choledochal cyst, 21 recurrent pancreatitis, 22 cholestatic jaundice, 23 traumatic pancreatic duct disruption, 24 and the investigation of bile leak following liver transplant. 25 In our series, two patients developed post-ERCP mild pancreatitis, which is comparable to the 10% complication rate of endoscopic sphincterotomy reported both in children and in adults.…”

Section: Discussionmentioning

confidence: 99%

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

1999

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The role of endoscopic retrograde cholangiopancreatography (ERCP) for the investigation and treatment of biliary and pancreatic diseases is well established in adults.1 This, however, is not the case in the pediatric age group, because biliary and pancreatic diseases are less common in children. In addition to this problem is the lack of pediatric gastroenterologists who are skilled in performing ERCP in children. Recently, however, and as a result of the routine use of ultrasonography in the evaluation of children with abdominal pain, biliary and pancreatic diseases are being diagnosed more often in children, 2 especially in areas where hemolytic diseases which are known to be associated with increased frequency of cholelithiasis and choledocholithiasis are common. 3-5The present study describes our experience with ERCP in the evaluation, diagnosis and treatment of pancreatobiliary disorders in children and demonstrates its value in the era of laparoscopic cholecystectomy. Patients and MethodsOver a four-year period from September 1993 to August 1997, 34 consecutive children less than 18 years old had ERCP as part of their management at our hospital. The records of these patients were reviewed retrospectively for age, gender, indication for ERCP, pre-ERCP investigations, results, complications of ERCP and post-ERCP management.Informed, written consent for ERCP was obtained from the child's parent. All ERCPs were performed in the Radiology Department. For patients 10 years old and below, ERCP was performed under general anesthesia with nasotracheal intubation. In those older than 10 years, ERCP was done under sedation only. Patients with sickle cell disease were hydrated with intravenous fluids starting the night before the procedure, at a rate of 1½ their maintenance requirements, and blood transfusions were given when necessary to increase their Hb to 10-12 g/dL. With the patients properly sedated, using meperedine (1 mg/kg) and diazepam (0.1-0.2 mg/kg), the Olympus JF1 T20 side-viewing duodenoscope was used in all the patients. After visualization, the ampulla of Vater was cannulated with tapered catheters and the pancreatic and biliary ducts were visualized by fluoroscopy during injection of Hexabrix (320 mg was diluted to 50%). Appropriate radiographs were obtained in all cases. Where indicated, sphincterotomy was performed using 5F sphincterotome (Olympus). Common bile duct stone extraction was performed with basket and balloon catheters. During the procedure, all patients were monitored with pulse oximetry with a cardiorespiratory trolley at the bedside. ResultsThe 34 children who had ERCP at Qatif Central Hospital as part of their management over the four-year study period comprised 20 males and 14 females. Their ages ranged from 5-18 years (mean 14.5 years). Of the 34 patients, 29 (85.3%) had sickle cell disease (SCD). Their mean HbS level was 77.8% (range 66.1-90.7) and their mean HbF level was 21% (range 7.2-37). The indications for ERCP are shown in Table 1. Obstructive jaundice was the most common i...

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Use of ERCP to identify the site of traumatic injuries of the main pancreatic duct in children

Cited by 66 publications

References 10 publications

Diagnostic and therapeutic ERCP in the pediatric age group

Diagnostic and therapeutic ERCP in the pediatric age group

Pancreatic Injuries in the United Arab Emirates

The Role of ERCP in the Evaluation, Diagnosis and Therapy of Biliary and Pancreatic Diseases in Children

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