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Pediatric pancreatic trauma: a 10-year retrospective analysis from two high-complexity centers in Medellín, Colombia
Mateo Londoño Barrientos1,2, Sofia Pinzón Calderon3,4, Carlos Alberto Lopez Zapata3
1Hospital Pablo Tobón Uribe, Medellín, Colombia. mateo.londono322@gmail.com.
Insights
Non-operative management is effective for stable pediatric patients with pancreatic trauma. Surgery is often needed for associated injuries, and postoperative pancreatic fistulas are a key complication.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Gastrointestinal Surgery
Background:
- Pediatric pancreatic trauma is rare but linked to significant morbidity.
- Management decisions hinge on hemodynamic stability and pancreatic duct involvement.
Purpose of the Study:
- To analyze the management and outcomes of pediatric pancreatic trauma.
- To identify factors influencing treatment decisions and complications.
Main Methods:
- Retrospective analysis of 25 pediatric patients with pancreatic trauma (2010-2020).
- Data included clinical variables, trauma mechanism, imaging, management strategies, and complications.
Main Results:
- Blunt trauma was the most common mechanism (64%).
- Non-operative management succeeded in 56% of cases; failures were due to clinical deterioration.
- Postoperative pancreatic fistula (ISGPS Grade B) occurred in 23% of operated patients, driving morbidity.
Conclusions:
- Non-operative management is feasible for hemodynamically stable children.
- Surgical intervention was primarily driven by associated injuries.
- Accurate grading and standardized reporting are crucial for pediatric pancreatic trauma management.
Purpose:
Pediatric pancreatic trauma is uncommon, but it is associated with significant morbidity and an ongoing debate regarding its management. Hemodynamic stability and pancreatic duct involvement are key factors in treatment decisions.
Methods:
A retrospective study analyzed 25 pediatric patients with pancreatic trauma treated between 2010 and 2020 at two high-complexity hospitals in Medellin. Clinical variables, trauma mechanism, imaging findings, management, and complications were analyzed.
Results:
Blunt trauma was the predominant mechanism (64%). Preoperative computed tomography was performed in 12 patients (48%); radiological AAST grading was not retrievable in 13 (52%). Immediate surgery was performed in 13 patients (52%), predominantly driven by associated intra-abdominal injuries rather than the pancreatic injury itself. Non-operative management was initially attempted in 9 patients (36%), with a 56% success rate; failures (44%) were related to clinical deterioration and progression of peripancreatic collections. Clinically relevant postoperative pancreatic fistula (ISGPS Grade B) occurred in 3 of 13 operated patients (23%), with a mean closure time of 55.6 days (range 18-110); no Grade A or Grade C fistulas were recorded. Other complications included post-traumatic pancreatitis (24%), pancreatic pseudocyst (8%), and organ/space surgical site infection (8%); most were Clavien-Dindo Grade IIIa. No in-hospital or 30-day deaths occurred.
Conclusions:
In this Latin American dual-centre cohort, non-operative management was feasible in hemodynamically stable children, while operative management was largely dictated by associated injuries rather than pancreatic injury itself. Clinically relevant POPF was the dominant driver of morbidity. Accurate grading, ductal assessment, and standardised outcome reporting (ISGPS, Clavien-Dindo) are essential to guide management and benchmark results.
