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The efficacy of early ERCP in pediatric pancreatic trauma
F J Rescorla1, D A Plumley, S Sherman
1Department of Surgery, Indiana University School of Medicine, Indianapolis, USA.
Insights
Endoscopic retrograde cholangiopancreatography (ERCP) can accurately diagnose pancreatic ductal injuries in children. This study shows ERCP
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Pancreatic injuries in children are often diagnosed late, with treatment strategies debated.
- Endoscopic retrograde cholangiopancreatography (ERCP) aids in identifying pancreatic duct injuries but has limited use in pediatric patients due to size and contamination concerns.
Purpose of the Study:
- To describe the authors' experience using ERCP for selected pediatric pancreatic injuries.
- To evaluate the role of ERCP in managing pancreatic ductal transections in children.
Main Methods:
- Retrospective review of six pediatric patients (ages 2.5-8 years) with blunt pancreatic transections treated between 1988 and 1993.
- ERCP was performed after initial computed tomography (CT) scans and, in some cases, drainage attempts.
Main Results:
- All six children had major ductal transections confirmed by ERCP.
- Initial CT scans were normal in five patients; subsequent scans revealed fluid collections.
- Three patients initially treated with drainage underwent ERCP due to treatment failure.
Conclusions:
- ERCP is a valuable tool for diagnosing major pancreatic ductal transections in pediatric blunt trauma.
- Despite initial concerns, ERCP can be safely employed in selected pediatric cases for accurate injury delineation.
Abstract:
Recognition of pancreatic injuries is frequently delayed, and optimal treatment is often controversial. The use of endoscopic retrograde cholangiopancreatography (ERCP) has allowed accurate delineation of pancreatic ductal injuries; however, the small size of children and the concern with inducing pancreatitis and/or lesser sac contamination have limited its use in children. In 1988, the authors began using ERCP for selected pancreatic injuries. This report describes their experience with this technique and examines the role of ERCP in pediatric pancreatic injuries. Six children with pancreatic transections resulting from blunt trauma were treated between 1988 and 1993. The age range was 2 1/2 to 8 years, and the weight range was 13.6 to 27.9 kg. The average period from injury to referral to the hospital was 14 days (range, 2 to 30 days). All six children presented with chemical evidence of pancreatitis and had an initial computed tomography (CT) scan; five scans were interpreted as being normal. Five of the six patients had subsequent CT scans, which showed lesser-sac fluid collection. Three patients were treated with drainage (2 percutaneous, 1 open [outside hospital]), and when this failed, ERCP was performed, at 13.6 days (average) after presentation. These three patients underwent ERCP relatively early in the course (an average of 3 days after presentation). All six children had major ductal transections documented through ERCP. After ERCP, the serum amylase level remained elevated in three, increased in one, and normal in one. (It was not measured in one of the recent cases taken for immediate operation.)(ABSTRACT TRUNCATED AT 250 WORDS)