创伤与治疗杂志

Management of Pancreatic Injuries with Blunt Abdominal Trauma in Children, Case Series

Abstract

Asem Ghasoup, Omar Sadieh, Ahmad Mansor, Qais Alani and Jamil Sawaqed

Objectives: Trauma is the leading cause of death in children. Abdominal trauma with Injuries to the liver, spleen and kidneys are common in children and many of these injuries nowadays are treated non-operatively, where as Pancreatic injuries are uncommon and its management still controversial. The aim of this study is to report the outcome of management in a series of children with pancreatic injury.
Methods: Ten Children less than 10 years of age treated at our institution with pancreatic injury between the period of May 2000 and May 2010 and reviewed retrospectively. 8 cases admitted from the emergency room and two cases referred from another facility. Diagnosis made on clinical suspicion, biochemistry tests and radiological confirmation (ultrasound and CT scan). Management was started according to the grade of Injury.
Results: Seven boys and three girls aged between 2.5 and 10 years sustained pancreatic injuries: three cases had grade I Pancreatic injury (minor contusion), three cases with grade II (major contusion without duct injury or tissue loss), two with grade III (distal transection and duct injury), one case with grade IV (proximal transection) and one case with pancreatic transaction and extensive duodenal injury (grade IV with associated injury). Grade I and II injuries were successfully managed without surgery. Children with grade III injuries were treated conservatively, but each developed a symptomatic pseudo cyst that failed to resolve with percutaneous drainage and underwent spleen-sparing distal pancreatectomy. The child with grade IV transected pancreatic neck was treated by Roux-en-Y jejunostomy drainage and the last case with the Grade IV and associated duodenal injury treated with Whipple procedure. Amylase level was normal in Grade I and II injuries and increased as the grade of injury is higher. All children made a full recovery. Median follow up was 45 days.
Conclusion: Pancreatic injuries in children are uncommon and its management still controversial, some Institutions prefers conservative management, whereas others hold on the surgical option. Level of amylase is correlated with the severity of the injury when pancreatic injury is diagnosed. The management of pancreatic injuries in children depends on the grade of injury, presence of associated injuries and Hospital expertise.