Management of blunt duodenal and pancreatic injuries in children (about a series of 8 cases)

• Published in: Tunisie Medicale Vol. 88; no. 8; p. 586
• Main Authors: Ben Hassine, Lilia, Boughanmi, Nizar, Douira, Wiem, Mormeche, Jihene, Louati, Hela, Hamzaoui, Mourad, Chaouachi, Beji, Bellagha, Ibtissem
• Format: Journal Article
• Language: French
• Published: Tunisia 01.08.2010
• Subjects: Accidental Falls; Accidents, Home; Accidents, Traffic; Age Factors; Bicycling - injuries; Child; Child, Preschool; Drainage; Duodenum - injuries; Endoscopy; Female; Humans; Male; Pancreas - injuries; Pancreatectomy; Radiography, Abdominal; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - diagnosis; Wounds, Nonpenetrating - diagnostic imaging; Wounds, Nonpenetrating - surgery; Wounds, Nonpenetrating - therapy
• ISSN: 0041-4131

The aim of this retrospective study is to report eight cases of blunt duodeno-pancreatic trauma in infants, emphasizing on the role of imaging in acute assessment of the lesions and in further management. We reported eight cases of duodeno-pancreatic injuries between 2006 and 2008, 5 boys and 3 girls with an age ranging from 3 to 12 years (median age: 7 years). Trauma circumstances were: car accident (n=2), domestic injury (n=5) and bicycle's fall injury (n=1). All patients underwent abdominal ultrasonography and CT scan in the initial evaluation and during the follow-up. Imaging showed the following pancreatic lesions: 3 corporeal fractures, 2 caudal fractures and one between the corporeal and the caudal portions. Four pancreatic haematomas were found. The associated lesions were duodenal, splenic, hepatic and renal. Two isolated duodenal haematomas were found. Two patients improved spontaneously, the six others developed complications: 4 acute pancreatitis, two infections, 3 pseudocysts and one retroperitoneal collection. Management was chirurgical in one case, medical in two cases, endoscopic in 2 cases and three percutaneaous drainages were performed. Blunt duodeno-pancreatic injuries in children have to be evaluated by an early imaging modality, in order to perform acute assessment of the lesions. Primary conservative treatment is advocated while clinic, biologic and imaging follow-up is required to detect complications, which management can be endoscopic, percutaneous or surgical.