Pancreatic trauma in children

Pancreatic trauma is rare in children, and management strategies are diverse and controversial. The aim of this study was to report the outcome of a consecutive series of children with pancreatic injury seen at a single regional centre over a decade.

All children under 14 years of age referred with pancreatic injury between January 1995 and June 2004 were reviewed retrospectively.

Nine children (six boys) aged 3-13 years sustained pancreatic injuries: one grade I (minor contusion), two grade II (major contusion without duct injury or tissue loss), five grade III (distal transection and duct injury) and one grade IV (proximal transection). Grade I and II injuries were successfully managed without surgery. The five children with grade III injuries were initially treated without operation, but each developed a large symptomatic pseudocyst that failed to resolve with percutaneous drainage. Four underwent a spleen-sparing distal pancreatectomy and one boy with a transected pancreatic neck was treated by Roux-en-Y jejunostomy drainage. A 6-year-old boy who sustained severe pancreatobiliary trauma (grade IV) was treated by Roux-en-Y drainage. All children made a full recovery.

The management of pancreatic injuries in children should be individualized depending on the site of injury, timing of referral, presence of associated injuries and institutional expertise.