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Conservative management of blunt pancreatic trauma in children: a single center experience
Olivier Abbo1, Aurélie Lemandat1, Nicolas Reina1
1Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
Insights
Nonoperative management is safe for pediatric blunt pancreatic trauma, even for severe injuries. While pseudocysts (PC) can occur in about 30% of cases, most can be managed conservatively or with minimally invasive procedures.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastroenterology
Background:
- Blunt pancreatic trauma affects approximately 10% of children with abdominal trauma.
- Nonoperative management is standard for Grades I and II injuries, but controversial for Grades III and IV.
- Pseudocyst (PC) formation is a potential complication requiring careful monitoring.
Purpose of the Study:
- To analyze the outcomes of nonoperative management for pediatric blunt pancreatic trauma.
- To specifically assess the incidence and management of pseudocysts (PC) in these patients.
Main Methods:
- Retrospective review of pediatric patients treated for pancreatic trauma between 1990 and 2010.
- Inclusion criteria: initial lipase >3x normal and abnormal CT scan.
- Injury grading (I-IV) and pseudocyst (PC) development were key outcome measures.
Main Results:
- 36 children (average age 8.7 years) were included; 36.1% had isolated trauma.
- Pancreatic injury grades: I (n=21), II (n=2), III (n=7), IV (n=6).
- Pseudocysts (PC) occurred in 30.5% (n=11), primarily in Grades III and IV, with an average 17-day delay. Conservative management was successful in 54.6% of PC cases; 5 required minimally invasive procedures.
Conclusions:
- Nonoperative management is a safe and effective approach for pediatric blunt pancreatic trauma, including higher-grade injuries.
- Pseudocyst (PC) development occurs in about 30% of cases but is often manageable conservatively or with minimally invasive techniques.
- This approach reduces the need for invasive procedures, with those required being exclusively minimally invasive.
Introduction:
Blunt trauma of the pancreas represents a significant part of abdomen trauma in children with an incidence estimated at around 10%. If the conservative management is widely accepted concerning the stages I and II, it remains controversial concerning stages III and IV. The aim of our study was to perform a descriptive analysis of the nonoperative management, with a focus on the occurrence of pseudocysts.
Materials And Methods:
The charts of the patients treated in our center for pancreatic trauma from 1990 to 2010 have been reviewed. It was defined by an initial lipase greater than three times the norm and an abnormal computed tomography scan.
Results:
A total of 36 patients were included, with 26 boys (72%) and 10 girls (28%) with an average age of 8.7 years. The trauma was isolated in 13 cases (36.1%) and in 23 cases, there were other associated lesions (mainly liver [n = 9] and spleen [n = 5]). Pancreatic injuries were graded as follows: I (n = 21), II (n = 2), III (n = 7), and IV (n = 6). Pseudocysts occurred in 11 patients (30.5%) mainly in grades III (n = 3) and IV (n = 7), with an average delay of 17 days. Initial management of pseudocysts was conservative in six patients (54.6%), whereas five patients required mini-invasive procedures.
Conclusion:
Nonoperative management remains a safe way to treat pancreatic injuries despite an average 30% rate of pseudocyst (PC) appearance. It allows a reduction in the number of children who required procedures to less than half of the patients where PC occurred. Furthermore, these procedures were exclusively mini-invasive.
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Assessment: