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Pancreatic injuries in childhood due to blunt trauma
S D Smith1, D K Nakayama, N Gantt
1Department of Pediatric Surgery, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA 15213.
Insights
Diagnosing major pancreatic injuries in children is challenging. Early surgical intervention for severe pancreatic injuries significantly reduces hospital stays and complications.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Pancreatic injuries in children are uncommon but can lead to significant morbidity.
- Distinguishing between minor and major pancreatic injuries is crucial for appropriate management.
- Previous studies have not clearly defined diagnostic factors or optimal treatment timing for pediatric pancreatic trauma.
Purpose of the Study:
- To identify diagnostic factors differentiating major (transections, pseudocysts) from minor (contusions, lacerations) pancreatic injuries in children.
- To assess the impact of diagnosis and treatment timing on the hospital course for major pancreatic injuries.
Main Methods:
- Retrospective review of 22 children with laparotomy-confirmed pancreatic injuries.
- Analysis of clinical presentation, serial serum amylase levels, and imaging findings (CT, ultrasound).
- Comparison of outcomes based on the timing of surgical intervention for major injuries.
Main Results:
- Abdominal tenderness was not a reliable differentiator between injury types.
- Rising serial serum amylase levels over 24-48 hours were associated with major injuries (P=0.05).
- Early laparotomy (within 24 hours) for major injuries resulted in a significantly shorter mean hospital stay (16.7 days) compared to delayed surgery (38.8 days).
Conclusions:
- Timely diagnosis and prompt surgical treatment of major pancreatic injuries in children can reduce hospitalization duration without increasing morbidity.
- Early identification of surgically significant pancreatic injuries remains a clinical challenge.
- Serial amylase monitoring and prompt surgical intervention are key components in managing pediatric pancreatic trauma.
Abstract:
The records of 22 children who suffered pancreatic injury in whom laparotomy confirmed the diagnosis were reviewed. First, we wished to define diagnostic factors that would distinguish transections and injuries that resulted in pseudocysts (which we termed major injuries) from contusions and lacerations that required no specific operation (minor injuries). Second, we wanted to determine how the timing of diagnosis and treatment of major injuries influenced hospital course. There were 13 major injuries (ten transections, three pseudocysts) and nine minor injuries. Abdominal tenderness (present in 83%) failed to distinguish major from minor injuries. Major injuries appeared to be associated with rising values of serum amylase taken serially over 24 to 48 hours (P = .05). Computerized tomography and ultrasound obtained in the first days after injury gave nonspecific findings and failed to give a definitive diagnosis. Of 13 patients with major injuries, seven underwent laparotomy within 24 hours of injury; six, two days or more. The mean hospital stay in the early group (16.7 days) was significantly shorter than that in the late group (38.8 days). Our review suggests that timely diagnosis of major pancreatic injuries and prompt surgical treatment can shorten hospitalization without increasing morbidity. The diagnosis of surgically significant pancreatic injuries continues to be a primary clinical challenge.