Surgical management of major pancreatic injury in children
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J Snajdauf1, M Rygl, J Kalousová
1Department of Pediatric Surgery, Charles University of Prague, 2nd Medical School, Teaching Hospital Motol, Institute of Postgraduate Medicine, Prague, Czech Republic. jiri.snajdauf@lfmotol.cuni.cz
Insights
Early surgery is crucial for pediatric pancreatic ductal injuries. Transferring children with suspected ductal injury to specialized centers improves outcomes, preventing long-term complications.
Area of Science:
- Pediatric surgery
- Trauma surgery
- Gastroenterology
Background:
- Major pancreatic trauma in children is rare, with debated management strategies.
- This study evaluates early versus delayed surgical interventions for pediatric pancreatic injuries.
Purpose of the Study:
- To assess the outcomes of early and delayed surgical management in pediatric patients with major or complicated pancreatic trauma.
- To identify optimal diagnostic and surgical approaches for pediatric pancreatic injuries.
Main Methods:
- Retrospective analysis of 13 pediatric patients (ages 3-16) with major/complicated pancreatic injury treated between 1994-2005.
- Injuries graded II-IV; pseudocysts developed in 8 patients.
- Surgical interventions included cystogastrostomy, distal pancreatectomy, and Roux-en-Y jejunostomy drainage.
Main Results:
- Endoscopic retrograde cholangiopancreaticography (ERCP) proved highly effective for diagnosing ductal injuries.
- No deaths or long-term morbidity were observed in the study cohort.
- Early diagnosis and operation were performed in 5 cases, delayed in 8.
Conclusions:
- Early surgical intervention is recommended for pediatric patients with pancreatic ductal injuries.
- Transfer to a tertiary center experienced in pediatric ERCP and pancreatic surgery is advised for suspected ductal injuries.
Introduction:
Major or complicated pancreatic trauma in children is uncommon and management strategies remain controversial. The aim of this study was to evaluate our experience with both early and delayed surgery in these pediatric cases.
Methods:
We carried out a retrospective analysis of data of pediatric patients with major or complicated pancreatic injury operated on between January 1994 and December 2005 in our pediatric trauma center.
Results:
Thirteen children (9 boys and 4 girls) with a mean age of 8.5 years (range 3 - 16 years) were operated for major or complicated pancreatic injury. The extent of injury was: grade II (major contusion without duct injury or tissue loss) in 4 children; grade III (distal transection) in 5 children and grade IV injury (proximal transection) in four patients. Pseudocyst developed in 8 children: 4 with grade II injury, 2 with grade III injury and 2 with grade IV injury (one with abdominal pseudocyst and one with an abdominal and a mediastinal pseudocyst). Early diagnosis and operation was achieved in 5 cases, while delayed diagnosis and operation occurred in 8. Three children underwent cystogastrostomy; 6 had a spleen-sparing distal pancreatectomy and 4 had resection with Roux-en-Y jejunostomy drainage. Endoscopic retrograde cholangiopancreaticography (ERCP) was the most useful diagnostic tool in assessing ductal injury. There were no deaths or long-term morbidity in our group of patients.
Conclusions:
Our results support the view that early operation is important in ductal pancreatic injury. We recommend transferring children with a suspected ductal injury to a tertiary center with experience in both pediatric ERCP and pancreatic surgery.
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