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Blunt pancreatic trauma in children
Baruch Klin1, Ibrahim Abu-Kishk, Igor Jeroukhimov
1Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, 70300, Israel.
Insights
Blunt pancreatic trauma in children requires prompt evaluation. Early endoscopic retrograde cholangiopancreatography (ERCP) aids in diagnosing pancreatic transection, guiding effective management strategies for pediatric patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Trauma Management
Background:
- Blunt pancreatic trauma is uncommon in children.
- Management strategies vary, necessitating a review of clinical experience.
Purpose of the Study:
- To describe the experience with blunt pancreatic trauma in pediatric patients.
- To evaluate different management approaches for these injuries.
Main Methods:
- A retrospective review of 10 pediatric patients with blunt pancreatic trauma over 10 years.
- Utilized diagnostic imaging including CT, ultrasonography, and ERCP.
- Classified injuries using a grading system (I-III).
Main Results:
- Most injuries resulted from accidents like bicycle handlebar impacts and falls.
- Grades I and II injuries were managed conservatively with success.
- Grade III injuries with ductal involvement required surgical intervention, with good outcomes.
- Early ERCP was performed in 4 patients.
Conclusions:
- Conservative management is effective for low-grade pancreatic injuries.
- Surgical intervention is necessary for high-grade injuries with ductal disruption.
- Early ERCP is crucial for suspected pancreatic transection in pediatric blunt trauma.
Purpose:
To report our experience with blunt pancreatic trauma in pediatric patients and evaluate several various management strategies.
Methods:
Ten children admitted over the last 10 years with pancreatic blunt trauma were included in the present series.
Results:
The average time from injury to hospital admission was 2.4 days. All injuries resulted from accidents: bicycle handlebar injuries (5), being kicked by a horse (2), falls from a height (2), and injury sustained during closure of an electric gate (1). Additional systemic and abdominal injuries were recorded in 7 patients. The amylase levels at the time of patient admission were normal in 3 patients, mildly raised in 4 patients, and elevated in 3 patients. Abdominal computed tomography was performed in 10 patients, ultrasonography in 5, and endoscopic retrograde cholangiopancreatography (ERCP) in 4. Pancreatic injuries comprised 4 grade I, 3 grade II, and 3 grade III injuries. Grade I and II injuries were successfully managed by conservative treatment. The 3 children with grade III trauma and pancreatic ductal injury in the neck (1), body (1), and tail (1) of the gland were surgically treated, having an uneventful postoperative stay of 8-14 days and no complications during the 1-year follow-up period.
Conclusion:
The present study supports early ERCP as an essential part of the initial patient evaluation when pancreatic transection is highly suspected.
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