Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Pancreatology. 2020 Jan;20(1):68-73. doi: 10.1016/j.pan.2019.10.008. Epub 2019 Oct 31.
To study the presentation, management strategies and long-term natural history of children with pancreatic trauma.
Children admitted with pancreatic trauma were analyzed for their presentation, management and outcome. Management included nasojejunal feeds, total parenteral nutrition (TPN), octreotide, drainage (radiological and endoscopic), endoscopic retrograde cholangiopancreatography (ERCP) and surgery. Patients were assessed in follow-up for development of chronic pancreatitis (CP).
36 children [29 boys, age 144 (13-194) months] presented at 30 (3-210) days after trauma. Most common cause of trauma was bicycle handle bar injury [n = 18,50%]. Presenting features were abdominal pain [n = 26,72%], lump [n = 16, 44.4%], ascites [n = 13,36%], pleural effusion [n = 9,25%] and anasarca [n = 3,8.3%]. All presented with sequelae of ductal disruption with pseudocyst, ascites or pleural effusion. Fifteen (41.6%) patients each had Grade III and IV injury, 4 (11%) had grade V, and grading was unavailable in 2. Other organs were injured in 4 (11%) cases. Management consisted of various combinations of nasojejunal feeds [n = 17,47.2%], TPN [n = 5,13.8%], octreotide [n = 13,36%], pseudocyst drainage [radiological (n = 18,50%), endoscopic (n = 3,8.3%)] and ERCP [n = 12,33.3%]. Surgical intervention was done in 2 (5.5%) cases [cystojejunostomy and peritoneal lavage in 1 each]. Two (5.5%) patients died due to sepsis. Of the 32 cases in follow-up, 19 (59.3%) recovered and 13 (40.6%) developed CP, with half (6/13) of them being symptomatic with recurrent pain.
Multi-disciplinary non-operative management is effective for managing pancreatic trauma in 94.4% of children, with 75% requiring radiological or endoscopic intervention. 40% developed structural changes later but only half were symptomatic.
研究儿童胰腺外伤的表现、处理策略和长期自然病程。
对因胰腺外伤而入院的患儿进行表现、处理和结局分析。处理包括鼻空肠喂养、全胃肠外营养（TPN）、奥曲肽、引流（放射学和内镜）、内镜逆行胰胆管造影（ERCP）和手术。对患儿进行随访，评估是否发生慢性胰腺炎（CP）。
36 名患儿[29 名男性，年龄 144（13-194）个月]在创伤后 30（3-210）天就诊。最常见的外伤原因是自行车把手受伤[n=18，50%]。主要表现为腹痛[n=26，72%]、肿块[n=16，44.4%]、腹水[n=13，36%]、胸腔积液[n=9，25%]和全身性水肿[n=3，8.3%]。所有患儿均有胰管破裂后继发假性囊肿、腹水或胸腔积液的后遗症。15 名（41.6%）患儿的损伤程度分别为 III 级和 IV 级，4 名（11%）为 V 级，2 名（5.5%）损伤程度不详。另外 4 名（11%）患儿合并其他器官损伤。处理方法包括鼻空肠喂养[n=17，47.2%]、TPN[n=5，13.8%]、奥曲肽[n=13，36%]、假性囊肿引流（放射学[n=18，50%]、内镜[n=3，8.3%]）和 ERCP[n=12，33.3%]。2 例（5.5%）患儿接受手术干预[各 1 例为胰肠吻合术和腹腔灌洗]。2 例（5.5%）患儿因脓毒症死亡。32 例在随访中，19 例（59.3%）康复，13 例（40.6%）发生 CP，其中一半（6/13）有复发性疼痛等症状。
多学科非手术治疗对 94.4%的儿童胰腺外伤有效，75%的患儿需要放射学或内镜干预。40%的患儿后来出现结构改变，但只有一半有症状。
