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Childhood pancreatic trauma: Clinical presentation, natural history and outcome
Aathira Ravindranath1, Anshu Srivastava1, Surender Kumar Yachha1
1Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Insights
Pediatric pancreatic trauma is often managed non-operatively, with most children recovering. However, a significant portion develop chronic pancreatitis (CP) later, though many remain asymptomatic.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Trauma Management
Background:
- Pancreatic trauma in children is rare but can lead to severe complications.
- Understanding the long-term outcomes of pediatric pancreatic injuries is crucial for effective management.
Purpose of the Study:
- To investigate the clinical presentation, management strategies, and long-term natural history of pancreatic trauma in pediatric patients.
- To assess the incidence of chronic pancreatitis (CP) following pancreatic trauma in children.
Main Methods:
- A retrospective analysis of children admitted with pancreatic trauma.
- Evaluation of management strategies including nutritional support (nasojejunal feeds, TPN), octreotide, drainage procedures (radiological, endoscopic), ERCP, and surgical interventions.
- Long-term follow-up to determine the development of CP.
Main Results:
- 36 children with pancreatic trauma were studied, with bicycle handlebar injuries being the most common cause.
- Presenting features included abdominal pain, palpable masses, ascites, and pleural effusions, often resulting from ductal disruption.
- Non-operative management, frequently involving drainage and nutritional support, was successful in most cases, though 40.6% developed CP, with half experiencing symptomatic pain.
Conclusions:
- Multi-disciplinary, non-operative management is highly effective for pediatric pancreatic trauma, with a high success rate.
- While many children recover, a substantial percentage develop chronic pancreatitis, highlighting the need for long-term monitoring.
Objectives:
To study the presentation, management strategies and long-term natural history of children with pancreatic trauma.
Methods:
Children admitted with pancreatic trauma were analyzed for their presentation, management and outcome. Management included nasojejunal feeds, total parenteral nutrition (TPN), octreotide, drainage (radiological and endoscopic), endoscopic retrograde cholangiopancreatography (ERCP) and surgery. Patients were assessed in follow-up for development of chronic pancreatitis (CP).
Results:
36 children [29 boys, age 144 (13-194) months] presented at 30 (3-210) days after trauma. Most common cause of trauma was bicycle handle bar injury [n = 18,50%]. Presenting features were abdominal pain [n = 26,72%], lump [n = 16, 44.4%], ascites [n = 13,36%], pleural effusion [n = 9,25%] and anasarca [n = 3,8.3%]. All presented with sequelae of ductal disruption with pseudocyst, ascites or pleural effusion. Fifteen (41.6%) patients each had Grade III and IV injury, 4 (11%) had grade V, and grading was unavailable in 2. Other organs were injured in 4 (11%) cases. Management consisted of various combinations of nasojejunal feeds [n = 17,47.2%], TPN [n = 5,13.8%], octreotide [n = 13,36%], pseudocyst drainage [radiological (n = 18,50%), endoscopic (n = 3,8.3%)] and ERCP [n = 12,33.3%]. Surgical intervention was done in 2 (5.5%) cases [cystojejunostomy and peritoneal lavage in 1 each]. Two (5.5%) patients died due to sepsis. Of the 32 cases in follow-up, 19 (59.3%) recovered and 13 (40.6%) developed CP, with half (6/13) of them being symptomatic with recurrent pain.
Conclusion:
Multi-disciplinary non-operative management is effective for managing pancreatic trauma in 94.4% of children, with 75% requiring radiological or endoscopic intervention. 40% developed structural changes later but only half were symptomatic.
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