Dev Harmanjit, Kikiros Colin
Department of Paediatric Surgery, Perth Children's Hospital, Nedlands, WA, Australia.
J Trauma Inj. 2023 Sep;36(3):310-314. doi: 10.20408/jti.2023.0013. Epub 2023 Aug 24.
Pancreatic trauma from a blunt injury is fairly uncommon in the pediatric population. Furthermore, such trauma with associated disruption of the pancreatic duct (PD) is even less prevalent and is associated with high morbidity and mortality. Pancreatic injuries in the pediatric population are often missed and hence require a thorough workup in children presenting with any form of abdominal injury. This case report describes a young boy who presented with abdominal pain and did not initially inform medical staff about any injury. For this reason, his initial provisional diagnosis was appendicitis, but he was later found to have transection of the pancreas with injury to the PD on imaging. The management of such injuries in pediatric patients often poses a challenge due to a lack of pediatric physicians trained to perform interventions such as endoscopic retrograde cholangiopancreatography. Furthermore, such interventions carry a higher risk when performed on children due to the smaller size of their pancreatic ducts. As a result, our patient had to be transferred to an adult center to undergo this procedure. Thus, maintaining a high degree of suspicion, along with a detailed history and examination, is crucial for the early diagnosis and management of pancreatic injuries.
钝性损伤导致的胰腺创伤在儿科人群中相当少见。此外，伴有胰管（PD）断裂的此类创伤更为罕见，且与高发病率和死亡率相关。儿科人群中的胰腺损伤常常被漏诊，因此对于任何形式腹部损伤的患儿都需要进行全面检查。本病例报告描述了一名出现腹痛的小男孩，他最初未告知医务人员任何受伤情况。因此，他最初的初步诊断为阑尾炎，但后来影像学检查发现他胰腺横断且胰管受损。由于缺乏接受过诸如内镜逆行胰胆管造影等干预措施培训的儿科医生，儿科患者此类损伤的处理常常具有挑战性。此外，由于儿童胰管尺寸较小，对其进行此类干预时风险更高。结果，我们的患者不得不转至成人中心接受该手术。因此，保持高度怀疑，以及详细的病史询问和体格检查，对于胰腺损伤的早期诊断和处理至关重要。
