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Selective management of pediatric pancreatic injuries
M S Firstenberg1, T A Volsko, C Sivit
1Rainbow Pediatric Trauma Center and Pediatric Radiology, Rainbow Babies and Children's Hospital, University Hospitals of Cleveland, OH 44106, USA.
Insights
Traumatic pancreatitis in children is challenging to diagnose and manage. Blunt pancreatic trauma (BPT) can often be managed nonoperatively, unlike penetrating injuries which have a high mortality rate.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Gastroenterology
Background:
- Trauma is the leading cause of pancreatitis in children.
- Diagnosis and management of pediatric traumatic pancreatitis present significant challenges.
Purpose of the Study:
- To review the diagnosis and management of pediatric traumatic pancreatitis.
- To evaluate outcomes of blunt pancreatic trauma (BPT) versus penetrating pancreatic trauma.
Main Methods:
- Retrospective review of pediatric patients with traumatic pancreatitis at a Level I Trauma Center.
- Analysis of hospital course, diagnostic procedures, surgical interventions, and complications.
Main Results:
- Twelve pediatric cases (0.35%) were reviewed; nine with blunt pancreatic trauma (BPT).
- Serial amylase levels were inconsistent in predicting injury severity.
- Endoscopic retrograde cholangiopancreatography (ERCP) aided in surgical decision-making.
- Pseudocysts developed in five children; mortality was 66% for penetrating injuries versus 0% for BPT.
Conclusions:
- A multimodal diagnostic approach (radiography, labs, ERCP) improves BPT diagnosis and management.
- Penetrating or main ductal injuries necessitate surgery.
- Most BPT cases can be managed nonoperatively with low morbidity and mortality.
Background:
Despite trauma being the most common cause of pediatric pancreatitis, the diagnosis and management is often difficult.
Methods:
The hospital course, diagnostic and surgical procedures, and complications for all children with traumatic pancreatitis evaluated at a Regional Level I Trauma Center were reviewed retrospectively.
Results:
Twelve of 3,500 children (0.35%, mean age, 8.7 +/- 1.2 years) were reviewed. Intraoperative diagnosis was made in three after penetrating trauma. Nine children sustained blunt pancreatic trauma (BPT) with serial radiographic imaging confirming the diagnosis in seven. Serial serum amylase levels, when performed, were normal in two and elevated in six, but did not predict injury severity or need for further intervention. Endoscopic retrograde cholangiopancreatography was performed in three children and indicated the need for surgical intervention in two and prevented planned laparotomy in one. Two children underwent computed tomography-guided fluid drainage. Pseudocysts developed in five children. Mortality rate from penetrating injuries was 66% with no deaths from BPT.
Conclusions:
A combination of serial radiographic, laboratory, and ERCP findings will improve the diagnosis and management of BPT. Penetrating or main ductal injuries require surgical intervention, and fluid collections may require drainage, but, otherwise, most BPT can be managed nonoperatively with minimal morbidity and mortality.
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