Nonoperative management of pancreatic injuries in children

• Published in: Journal of pediatric surgery Vol. 33; no. 2; pp. 343 - 349
• Main Authors: Shilyansky, Joel, Sena, Laureen M, Kreller, Margaret, Chait, Peter, Babyn, Paul S, Filler, Robert M, Pearl, Richard H
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.1998
• Subjects: Abdominal Injuries - complications; Child; Diagnostic Imaging; Humans; Pancreas - injuries; Pancreatic Pseudocyst - epidemiology; Pancreatic Pseudocyst - etiology; Pancreatic Pseudocyst - therapy; Parenteral Nutrition, Total; Retrospective Studies; Time Factors; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - epidemiology; Wounds, Nonpenetrating - therapy; trauma; nonoperative management; pseudocyst; Pancreatic injury
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/S0022-3468(98)90459-6

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.