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Early operation in children with pancreas transection
D E Meier1, C D Coln, B A Hicks
1Division of Pediatric Surgery, Children's Medical Center of Dallas, The University of Texas Southwestern Medical Center, Dallas, TX 75235, USA.
Insights
Early surgical intervention for pediatric pancreatic transection leads to faster recovery and reduced stress compared to nonoperative management. Prompt diagnosis is crucial for optimal outcomes in these rare injuries.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Major pancreatic ductal injury in children is a rare and challenging condition.
- Optimal management strategies for pediatric pancreatic transection are debated.
- This study evaluates early operative intervention versus other management approaches.
Purpose of the Study:
- To compare the outcomes of early surgical operation for pancreatic transection in children.
- To assess the effectiveness of early intervention against nonoperative management.
- To highlight the importance of timely diagnosis and treatment.
Main Methods:
- Retrospective analysis of pediatric patients with pancreatic transection.
- Data collected from Children's Medical Center of Dallas (1995-1999).
- Comparison of early operative versus nonoperative treatment groups.
Main Results:
- Eleven children with pancreatic transection were identified.
- Diagnosis was often delayed, with a mean delay of 36 hours in some cases.
- Nine children treated with early operation (within 72 hours) had an average hospital stay of 11 days, with low morbidity.
Conclusions:
- Early pancreatic resection in children expedites recovery and reduces hospitalization stress.
- Delayed diagnosis is common, necessitating a high index of suspicion and advanced imaging like CT scans.
- Early surgical management appears superior to nonoperative approaches for pediatric pancreatic transection.
Background/Purpose:
The preferred treatment for children with major pancreatic ductal injury remains controversial. This report compares our results using early operation with previously reported series using both operative and nonoperative management.
Methods:
This is a retrospective analysis of all children with pancreatic transection identified at Children's Medical Center of Dallas, Texas, from 1995 through 1999.
Results:
There were 11 children with pancreatic transection. There was a delay of 2.3 days before presentation to a hospital in 6. Transection was diagnosed within 12 hours of presentation in 5 children. In the other 6 there was a mean delay of 36 hours. Nine children underwent operation within 72 hours of injury. Two late presenters initially were treated nonoperatively, and both developed a pseudocyst. The length of hospital stay in patients undergoing early operation averaged 11 days. Early postoperative morbidity occurred in 4 children and late morbidity in 1.
Conclusions:
Major pancreatic injuries are uncommon in children, and the diagnosis often is delayed. A high index of suspicion and repeated computed tomography scans should lead to earlier diagnosis. When compared with nonoperative management, early pancreatic resection more expeditiously returns the child to good health and lessens the inconvenience and emotional stress associated with prolonged hospitalization.
