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Robotic Spleen-Preserving Distal Pancreatectomy: The Warshaw and Kimura Techniques
Published on: July 26, 2024
[Distal pancreatectomy with splenic preservation in pediatric patient with blunt abdominal trauma]
J T Palacios-Zertuche1, J G Martínez-Flores2, Q Gilte-Limas1
1Servicio de Cirugía General. Hospital Universitario "Dr. José Eleuterio González" de la Universidad Autónoma de Nuevo León. Monterrey, Nuevo León, México.
Insights
Pediatric pancreatic trauma requires prompt evaluation. Surgery is recommended for severe pancreatic injuries (grade III or higher), while less severe injuries (grades I-II) can be managed non-surgically.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Abdominal Trauma
Background:
- Blunt abdominal trauma in children can cause pancreatic injuries, with a significant mortality rate of 30%.
Observation:
- A 4-year-old girl sustained blunt abdominal trauma.
- CT scan revealed grade II liver and splenic lesions, and a grade III pancreatic lesion.
- Laparotomy confirmed the lesions, and distal pancreatectomy was performed, preserving splenic vessels.
Findings:
- The patient recovered well after distal pancreatectomy.
- No surgical complications were noted at four-month follow-up.
- Conservative management was used for liver and splenic lesions.
Implications:
- Surgical intervention is the primary treatment for high-grade pancreatic injuries (grade III+).
- Non-operative management is suitable for low-grade pancreatic injuries (grades I-II).
- This case highlights successful surgical management of pediatric pancreatic trauma.
Introduction:
Traumatic injuries of the pancreas occur in 3 to 12% of cases of blunt abdominal trauma in children and these are associated with a mortality of 30%.
Case Report:
A four-year-old girl was brought to the emergency room after an automobile accident. On physical examination, she was stable with abdominal pain and signs of peritoneal irritation. An abdominal CT scan showed a grade II liver lesion, a grade II splenic lesion, and a grade III pancreatic lesion. Laparotomy was performed with the patient stable, finding the same lesions as those on the CT scan. Distal pancreatectomy was performed preserving the splenic vessels. The liver and splenic lesions were conservatively treated. The patient was discharged on the seventh day after surgery and at four month follow-up no surgical complications have been observed.
Discussion:
Surgery should be considered first-line therapy for grade III or greater pancreatic lesions; conservative medical management should be used for Grade I and II lesions.
