Blunt pancreatic trauma in children.

PURPOSE

To report our experience with blunt pancreatic trauma in pediatric patients and evaluate several various management strategies.

METHODS

Ten children admitted over the last 10 years with pancreatic blunt trauma were included in the present series.

RESULTS

The average time from injury to hospital admission was 2.4 days. All injuries resulted from accidents: bicycle handlebar injuries (5), being kicked by a horse (2), falls from a height (2), and injury sustained during closure of an electric gate (1). Additional systemic and abdominal injuries were recorded in 7 patients. The amylase levels at the time of patient admission were normal in 3 patients, mildly raised in 4 patients, and elevated in 3 patients. Abdominal computed tomography was performed in 10 patients, ultrasonography in 5, and endoscopic retrograde cholangiopancreatography (ERCP) in 4. Pancreatic injuries comprised 4 grade I, 3 grade II, and 3 grade III injuries. Grade I and II injuries were successfully managed by conservative treatment. The 3 children with grade III trauma and pancreatic ductal injury in the neck (1), body (1), and tail (1) of the gland were surgically treated, having an uneventful postoperative stay of 8-14 days and no complications during the 1-year follow-up period.

CONCLUSION

The present study supports early ERCP as an essential part of the initial patient evaluation when pancreatic transection is highly suspected.