Pancreatic trauma in children

Abstract

Abstract Background Pancreatic trauma is rare in children, and management strategies are diverse and controversial. The aim of this study was to report the outcome of a consecutive series of children with pancreatic injury seen at a single regional centre over a decade. Methods All children under 14 years of age referred with pancreatic injury between January 1995 and June 2004 were reviewed retrospectively. Results Nine children (six boys) aged 3–13 years sustained pancreatic injuries: one grade I (minor contusion), two grade II (major contusion without duct injury or tissue loss), five grade III (distal transection and duct injury) and one grade IV (proximal transection). Grade I and II injuries were successfully managed without surgery. The five children with grade III injuries were initially treated without operation, but each developed a large symptomatic pseudocyst that failed to resolve with percutaneous drainage. Four underwent a spleen-sparing distal pancreatectomy and one boy with a transected pancreatic neck was treated by Roux-en-Y jejunostomy drainage. A 6-year-old boy who sustained severe pancreatobiliary trauma (grade IV) was treated by Roux-en-Y drainage. All children made a full recovery. Conclusion The management of pancreatic injuries in children should be individualized depending on the site of injury, timing of referral, presence of associated injuries and institutional expertise.