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Pancreatic and gastrointestinal trauma in children
Insights
Blunt abdominal trauma in children often causes pancreatic and gastrointestinal injuries, with diagnosis delays leading to complications. Early recognition and appropriate management are crucial for improving outcomes in pediatric trauma patients.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Blunt abdominal trauma is a significant cause of morbidity and mortality in children.
- Delays in diagnosing pancreatic and gastrointestinal injuries in pediatric patients contribute to poor outcomes.
- Anatomical factors and communication challenges can impede timely diagnosis.
Purpose of the Study:
- To review the diagnosis and management of pancreatic and gastrointestinal injuries in pediatric blunt abdominal trauma.
- To identify factors contributing to diagnostic delays and their impact on patient outcomes.
- To evaluate the effectiveness of different treatment modalities.
Main Methods:
- Retrospective review of pediatric patients with blunt abdominal trauma.
- Analysis of diagnostic methods, including physical examination, laboratory tests, and imaging studies.
- Evaluation of surgical and conservative management strategies for pancreatic and gastrointestinal injuries.
Main Results:
- Pancreatic injuries, including pseudocysts, were noted in 11 of 16 patients, often with elevated serum amylase.
- Gastrointestinal injuries involved the duodenum, jejunum, ileum, and stomach, with perforations being most common (65%).
- Diagnostic delays were prevalent, leading to misdiagnosis in some cases; internal drainage was effective for pancreatic pseudocysts, and simple closures for perforations.
Conclusions:
- Timely diagnosis and appropriate management are critical for improving outcomes in pediatric blunt abdominal trauma.
- Internal drainage is effective for pancreatic pseudocysts, while simple closures are often sufficient for gastrointestinal perforations.
- Further research into optimizing diagnostic strategies and treatment protocols is warranted.
Abstract:
Injuries to the pancreas and gastrointestinal tract following blunt abdominal trauma continue to be a significant cause of morbidity and mortality in the pediatric age group. Optimal treatment of these injuries is frequently hampered by considerable delays in diagnosis. Factors contributing to these delays include the location of much of the duodenum and the pancreas in the retroperitoneum resulting in an absence of initial symptoms and signs, the often trivial nature of some of the responsible blunt traumatic accidents, inappropriate child-parent or child-physician communication, failure to achieve a meaningful physical examination in uncooperative or unconscious patients, and false negative paracentesis. Eighty per cent of these injuries occurred in boys. Eleven of 16 patients with pancreatic trauma had pseudocysts. A persistently elevated serum amylase level was invariably noted and epigastric mass was palpable in eight patients. Significant delays in diagnosis were prevalent and pseudocysts was misdiagnosed as appendicitis in three cases. Internal drainage by cystgastrostomy or cystjejunostomy was effective operative treatment. In instances of acute pancreatic injuries, sump drains, gastrostomy, cholecystostomy, and total parenteral hyperalimentation were useful therapeutic adjuncts. There was one death for a 6.2 per cent mortality rate. Forty patients had gastrointestinal injuries involving the duodenum in 17, jejunum in 14, ileum in seven, and stomach in two. Perforations occured in 65 per cent of cases, obstructing hematomas in 30 per cent, and mesenteric avulsions in 5 per cent. Associated injuries were observed in 15 patients (37.5 per cent). Pain and tenderness were the only consistent findings. Upper gastrointestinal contrast studies were diagnostic of duodenal hematomas. Eighty per cent of perforations were managed by simple closures and 20 per cent by resection and anastomosis. Obstructing hematomas unassociated with other injuries may be expected to resolve without requiring operation in 50 per cent of patients managed conservatively. Complications occurred in 35 per cent of patients and the mortality rate was 12.5 per cent (five deaths).