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Blunt injury to the pancreas in children: selective management based on ultrasound
A Gorenstein1, D O'Halpin, D E Wesson
1Department of Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Blunt pancreatic trauma in children can often be managed nonoperatively. Abdominal ultrasound is crucial for diagnosing injuries and guiding treatment, showing surgical intervention isn't always necessary.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Trauma Management
Background:
- Blunt pancreatic injuries in children are uncommon but can lead to significant morbidity.
- Management strategies have evolved, with increasing consideration for nonoperative approaches.
Purpose of the Study:
- To evaluate the outcomes of nonoperative and operative management of blunt pancreatic trauma in pediatric patients.
- To assess the utility of abdominal ultrasound in diagnosing and guiding treatment for pancreatic injuries.
Main Methods:
- Retrospective review of 21 pediatric patients with blunt pancreatic trauma over a 5-year period.
- Patients were divided into two groups based on time to presentation (within 24 hours vs. >24 hours).
- Treatment strategies included operative and nonoperative management, with outcomes assessed.
Main Results:
- Six out of ten post-traumatic pancreatic pseudocysts resolved without surgical intervention.
- Abdominal ultrasound (US) was the most useful diagnostic tool, accurately identifying pancreatic lesions.
- Nonoperative management was successful in several cases, including obstructive pancreatitis and contusions.
Conclusions:
- Surgical intervention is not always required for pediatric blunt pancreatic trauma.
- Abdominal ultrasound plays a vital role in objective management guidance for pancreatic injuries.
- Nonoperative management should be strongly considered for select pediatric pancreatic trauma cases.
Abstract:
Twenty-one children with blunt injuries to the pancreas were treated over a 5-year period. Group I consisted of 12 patients brought to our hospital within 24 hours of injury. Group II included nine patients who were referred to us more than 24 hours after injury following initial treatment at another hospital. Two group I patients died within four hours of admission from other causes. Three had early laparotomy for other injuries. Of these, two had a contusion and one had a complete transection of the pancreas. All recovered uneventfully after appropriate surgical treatment. The remaining seven were all treated nonoperatively. Two had obstructive pancreatitis secondary to duodenal hematomas, three had pancreatic contusions, and two developed pancreatic pseudocysts. All seven recovered completely without operation. In group II, three patients had undergone laparotomy elsewhere. All three had pancreatic contusions. However, only one had appropriate drainage of the injured pancreas; he recovered uneventfully. Two, who were not drained, developed pseudocysts and one of these required surgical drainage by cystgastrostomy. The other six patients in group II presented to our hospital with established pseudocysts. Three of these resolved with nonoperative treatment but three required drainage. Overall, six of ten posttraumatic pancreatic pseudocysts resolved without surgical treatment. The single most useful diagnostic test in the management of these patients was abdominal ultrasound (US). US revealed specific anatomic lesions of the pancreas--contusion, obstructive pancreatitis, or pseudocyst--and provided an objective guide to management. Surgical intervention is not necessary in all cases of pancreatic trauma.