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Nonoperative management of pancreatic injuries in children
J Shilyansky1, L M Sena, M Kreller
1Department of Surgery, University of Toronto, Hospital for Sick Children, Ontario, Canada.
Insights
Nonoperative management is safe and effective for pediatric pancreatic contusions and transections. Most cases, including pseudocysts, resolved without surgery, demonstrating successful outcomes.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Gastroenterology
Background:
- Pancreatic injuries in children can result from trauma.
- Nonoperative management strategies are increasingly explored for pediatric pancreatic injuries.
Purpose of the Study:
- To evaluate the safety and efficacy of nonoperative management for pediatric pancreatic contusions and transections.
- To review outcomes of 35 children with pancreatic injuries over 10 years.
Main Methods:
- Retrospective review of 35 children with pancreatic injuries.
- Diagnosis confirmed via clinical presentation, elevated amylase, and imaging (ultrasound/CT).
- Nonoperative treatment involved withholding enteral feedings and utilizing total parenteral nutrition.
Main Results:
- 28 of 35 children were treated nonoperatively for pancreatic contusion, transection, or pseudocyst.
- Pseudocysts developed in 10 children and were managed nonoperatively, with 6 requiring percutaneous drainage.
- Average hospital stay was 21 days, with complete resolution of symptoms and radiographic abnormalities.
Conclusions:
- Nonoperative management is effective and safe for radiologically diagnosed pancreatic contusions and transections in children.
- Pseudocysts secondary to pancreatic injury can be successfully managed nonoperatively, with percutaneous drainage as an option for symptomatic cases.
Purpose:
The safety and efficacy of nonoperative management of pancreatic contusions and transections was examined by reviewing the case histories of 35 consecutive children with pancreatic injuries treated over the past 10 years.
Methods/Results:
Surgical exploration was performed for the management of associated injuries only. The diagnosis of pancreatic trauma was suspected in children with abdominal pain, tenderness, elevated serum amylase levels and findings consistent with pancreatic injury on abdominal ultrasound scan or computerized tomography (CT) examination. After children were diagnosed with pancreatic injury, enteral feedings were withheld and total parenteral nutrition administered until abdominal pain resolved and serum amylase levels and radiographic findings improved. Twenty-three children received diagnosis within 24 hours of injury, and in 12, the diagnosis was delayed 2 to 14 days. Hyperamylasemia was found in 27 of 35 children. Twenty-eight children sustaining pancreatic injuries were treated nonoperatively. Abdominal imaging in these children demonstrated pancreatic contusion in 14, transection in 11, and pseudocyst in three. Enteral feeding resumed an average of 15 days after injury. The average hospital stay was 21 days. Pseudocysts formed in 10 children (2 of 14 with contusion; 5 of 11 with transection; three children presented late, and the type of pancreatic injury could not be determined), whose average hospital stay was 25 days. All pseudocysts were successfully managed nonoperatively, although percutaneous aspiration or drainage was required in six children. Children underwent follow-up for an average of 10 months after injury (range, 1 to 144 months). Abdominal pain and radiological abnormalities resolved in all children before discharge from the clinic.
Conclusions:
Nonoperative management of pancreatic contusion and transection diagnosed radiologically is effective and safe. Pseudocysts may form after pancreatic injury, and if large or symptomatic, can be managed successfully by percutaneous drainage.