Grosfeld J L, Cooney D R
Pediatr Clin North Am. 1975 May;22(2):365-77. doi: 10.1016/s0031-3955(16)33136-4.
Injuries to the pancreas and gastrointestinal tract following blunt abdominal trauma continue to be a significant cause of morbidity and mortality in the pediatric age group. Optimal treatment of these injuries is frequently hampered by considerable delays in diagnosis. Factors contributing to these delays include the location of much of the duodenum and the pancreas in the retroperitoneum resulting in an absence of initial symptoms and signs, the often trivial nature of some of the responsible blunt traumatic accidents, inappropriate child-parent or child-physician communication, failure to achieve a meaningful physical examination in uncooperative or unconscious patients, and false negative paracentesis. Eighty per cent of these injuries occurred in boys. Eleven of 16 patients with pancreatic trauma had pseudocysts. A persistently elevated serum amylase level was invariably noted and epigastric mass was palpable in eight patients. Significant delays in diagnosis were prevalent and pseudocysts was misdiagnosed as appendicitis in three cases. Internal drainage by cystgastrostomy or cystjejunostomy was effective operative treatment. In instances of acute pancreatic injuries, sump drains, gastrostomy, cholecystostomy, and total parenteral hyperalimentation were useful therapeutic adjuncts. There was one death for a 6.2 per cent mortality rate. Forty patients had gastrointestinal injuries involving the duodenum in 17, jejunum in 14, ileum in seven, and stomach in two. Perforations occured in 65 per cent of cases, obstructing hematomas in 30 per cent, and mesenteric avulsions in 5 per cent. Associated injuries were observed in 15 patients (37.5 per cent). Pain and tenderness were the only consistent findings. Upper gastrointestinal contrast studies were diagnostic of duodenal hematomas. Eighty per cent of perforations were managed by simple closures and 20 per cent by resection and anastomosis. Obstructing hematomas unassociated with other injuries may be expected to resolve without requiring operation in 50 per cent of patients managed conservatively. Complications occurred in 35 per cent of patients and the mortality rate was 12.5 per cent (five deaths).
钝性腹部创伤后胰腺和胃肠道损伤仍是儿童年龄组发病和死亡的重要原因。这些损伤的最佳治疗常常因诊断的显著延迟而受阻。导致这些延迟的因素包括十二指肠和胰腺的大部分位于腹膜后，导致最初没有症状和体征；一些钝性创伤事故往往性质轻微；儿童与家长或儿童与医生之间沟通不当；在不合作或无意识的患者中未能进行有意义的体格检查；以及腹腔穿刺术假阴性。这些损伤80%发生在男孩。16例胰腺创伤患者中有11例出现假性囊肿。总是会发现血清淀粉酶水平持续升高，8例患者可触及上腹部肿块。诊断的显著延迟很常见，3例假性囊肿被误诊为阑尾炎。通过囊肿胃造口术或囊肿空肠造口术进行内引流是有效的手术治疗方法。在急性胰腺损伤的情况下，引流管引流、胃造口术、胆囊造口术和全胃肠外营养是有用的治疗辅助手段。有1例死亡，死亡率为6.2%。40例患者有胃肠道损伤，其中十二指肠损伤17例，空肠损伤14例，回肠损伤7例，胃损伤2例。65%的病例发生穿孔，30%的病例为梗阻性血肿，5%的病例为肠系膜撕裂。15例患者（37.5%）观察到合并伤。疼痛和压痛是唯一一致的表现。上消化道造影检查可诊断十二指肠血肿。80%的穿孔通过简单缝合处理，20%通过切除吻合处理。在保守治疗的患者中，50%与其他损伤无关的梗阻性血肿可望无需手术即可消退。35%的患者发生并发症，死亡率为12.5%（5例死亡）。
