Related Experiment Videos
Management of transected pancreas in children
E D McGahren1, D Magnuson, R T Schaller
1Department of Surgery, Children's Hospital and Medical Center, Seattle, WA 98105, USA.
Insights
Blunt pancreatic injuries in children often require surgical intervention when the main pancreatic duct is transected. Early surgical management, including spleen-preserving distal pancreatectomy, leads to shorter hospital stays and reduced long-term morbidity.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastroenterology
Background:
- Blunt abdominal trauma is a common cause of pancreatic injury in children.
- Management of pediatric pancreatic injuries remains controversial, with a trend towards non-operative approaches.
- Non-operative management can lead to prolonged hospital stays and complications like pseudocysts.
Observation:
- Five pediatric cases of blunt pancreatic injury with main pancreatic duct transection were identified.
- These patients underwent spleen-preserving distal pancreatectomy.
- This surgical approach resulted in shorter hospitalizations and minimal long-term morbidity.
Findings:
- Early operative management, specifically spleen-preserving distal pancreatectomy, is recommended for pediatric pancreatic injuries involving main duct transection.
- Endoscopic retrograde cholangiopancreatography (ERCP) is crucial for diagnosing pancreatic duct status.
- ERCP can also serve a therapeutic role in select cases.
Implications:
- Early surgical intervention for transected pancreatic ducts in children can improve outcomes.
- Spleen-preserving distal pancreatectomy offers a viable surgical option with reduced morbidity.
- Accurate diagnosis of pancreatic duct integrity is critical for optimal treatment planning in pediatric blunt abdominal trauma.
Abstract:
The pancreas is the fourth most commonly injured intra-abdominal organ in children who sustain blunt abdominal trauma. Appropriate management of the injured pancreas has been controversial. With the advent of the computerized tomography scan, paediatric surgeons have tended to manage pancreatic injuries non-operatively. However, if pseudocysts develop, non-operative management may necessarily entail a long hospital course involving total parenteral nutrition, drainage procedures and attendant morbidity. The critical element in planning therapy is to determine the status of the pancreatic duct. We have recently encountered five children who suffered blunt pancreatic injury where the main pancreatic duct was determined to have been transected. These children underwent spleen preserving distal pancreatectomy with resultant shorter hospital stays and minimal long-term morbidity. We suggest that in children with pancreatic injury where the main pancreatic duct has been transected early operative management rather than non-operative therapy is the procedure of choice. Endoscopic retrograde cholangiopancreatography should be used to determine the status of the pancreatic duct. This modality can be both diagnostic and therapeutic in appropriate circumstances.