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Non Operative Approach to Isolated Traumatic Pancreatic Duct Disruption
Sheshang U Kamath1, Satish B Dharap2
1Post Graduate Student, Lokmanya Tilak Municipal Medical College and General Hospital , Mumbai, Maharashtra India .
Insights
Conservative management of traumatic pancreatic duct injury in children can lead to pseudocyst formation. While some resolve spontaneously, others may require minimally invasive endoscopic treatment.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Trauma Management
Background:
- Isolated traumatic pancreatic duct disruption presents significant management challenges.
- High morbidity and mortality rates are associated with pancreatic duct injuries.
Observation:
- Two pediatric cases of isolated pancreatic ductal disruption were managed non-operatively.
- Both patients developed pancreatic pseudocysts following the injury.
Findings:
- One pseudocyst resolved spontaneously due to distal pancreas atrophy in a 5-year-old girl.
- A persistent pseudocyst in an 8-year-old boy was successfully treated with endoscopic cystogastrostomy.
Implications:
- Non-operative management of pancreatic duct injury may be considered, anticipating pseudocyst development.
- Spontaneous resolution or minimally invasive endoscopic treatment are potential outcomes for these pseudocysts.
- The literature suggests non-operative management is not standard due to potential complications.
Abstract:
Management of isolated traumatic pancreatic duct disruption remains challenging due to associated morbidity and mortality. Two children with isolated pancreatic ductal disruption were treated conservatively. Both developed a pseudocyst which resolved spontaneously due to the atrophy of the distal pancreas in a five-year-old girl while remained persistent and was treated by endoscopic cystogastrostomy in an eight-year-old boy. Non-operative management may be pursued in patients with pancreatic ductal injury in the hope of a pseudocyst formation which may spontaneously resolve or may be treated later with a minimally invasive procedure. However, the literature review precludes its practice as a standard due to high incidence of associated complications of non-operative management.
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