Advertisement

Management of Blunt Pancreatic Trauma in Children

  • Grace Z. MakEmail author
Chapter
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)

Abstract

Pancreatic injury following blunt trauma in children is quite rare. Management of mild pancreatic injuries not involving the main duct is generally non-operative. However, the management of more severe injuries involving the main pancreatic duct is much more controversial with proponents for both non-operative as well as early operative intervention. Both treatment strategies have their advantages and disadvantages with no consistent findings allowing for a definitive best practice to be developed. While non-operative management generally leads to longer initial hospital stays and increased pseudocyst formation as well as multiple endoscopic or less invasive procedures, the child avoids a major abdominal operation and pancreatic resection. Operative management, on the other hand, generally leads to decreased hospital stay and quicker return to normal function but involves the inherent risks of a major abdominal surgery, long-term consequences of pancreatic resection and possible splenectomy, as well as increased incidence of pancreatic leak or fistulas. Furthermore, there have been no reported long-term differences between the two strategies. Due to the rarity of children with pancreatic duct injuries following blunt trauma, there have thus far been no randomized controlled studies comparing the two treatment modalities. The literature consists of only retrospective reviews making a strong recommendation for best practice impossible. Thus, both are viable options for the treatment of pancreatic duct injuries.

Keywords

Pediatric pancreatic injury Blunt pancreatic injury Pancreatic duct transection Early operative management 

References

  1. 1.
    Haugaard MV, Wettergren A, Hillingsø JG, Gluud C, Penninga L. Non-operative versus operative treatment for blunt pancreatic trauma in children. Cochrane Database Syst Rev. 2014 Feb 12;2.Google Scholar
  2. 2.
    Iqbal CW, St Peter SD, Tsao K, Cullinane DC, Gourlay DM, Ponsky TA, Wulkan ML, Adibe OO, Pancreatic Trauma in Children (PATCH) Study Group. Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes. J Am Coll Surg. 2014;218(2):157–62.CrossRefPubMedGoogle Scholar
  3. 3.
    Maeda K, Ono S, Baba K, Kawahara I. Management of blunt pancreatic trauma in children. Pediatr Surg Int. 2013;29:1019–22.CrossRefPubMedGoogle Scholar
  4. 4.
    Paul MD, Mooney DP. The management of pancreatic injuries in children: operate or observe. J Pediatr Surg. 2011;46:1140–3.CrossRefPubMedGoogle Scholar
  5. 5.
    Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, Harrison P, Davenport M. Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg. 2007;42:629–35.CrossRefPubMedGoogle Scholar
  6. 6.
    Canty TG, Weinman D. Treatment of pancreatic duct disruption in children by an endoscopically placed stent. J Pediatr Surg. 2001;36(2):345–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Canty TG, Weinman D. Management of major pancreatic duct injuries in children. J Trauma. 2001;50(6):1001–7.CrossRefPubMedGoogle Scholar
  8. 8.
    Meier DE, Coln CD, Hicks BA, Guzzetta PC. Early operation in children with pancreas transection. J Pediatr Surg. 2001;36(2):341–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Nadler EP, Gardner M, Schall L, Lynch J, Ford H. Management of blunt pancreatic injury in children. J Trauma: Inj Infect Crit Care. 1999;47(6):1098.CrossRefGoogle Scholar
  10. 10.
    Thomas H, Madanur M, Bartlett A, Marangoni G, Heaton N, Rela M. Pancreatic trauma – 12-year experience from a tertiary center. Pancreas. 2009;38(2):113–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Wood JH, Patrick DA, Bruny JL, Sauaia A, Moulton SL. Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg. 2010;45:401–6.CrossRefPubMedGoogle Scholar
  12. 12.
    Mattix KD, Tataria M, Holmes J, Kristoffersen K, Brown R, Groner J, Scaife E, Mooney D, Nance M, Scherer L. Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes. J Pediatr Surg. 2007;42(2):340–4.CrossRefPubMedGoogle Scholar
  13. 13.
    Beres AL, Wales PW, Christison-Lagay ER, McClure ME, Fallat ME, Brindle ME. Non-operative management of high-grade pancreatic trauma: is it worth the wait? J Pediatr Surg. 2013;48:1060–4.CrossRefPubMedGoogle Scholar
  14. 14.
    Snajdauf J, Rygl M, Kalousová J, Kucera A, Petrů O, Pýcha K, Mixa V, Keil R, Hríbal Z. Surgical management of major pancreatic injury in children. Eur J Pediatr Surg. 2007;17(5):317–21.CrossRefPubMedGoogle Scholar
  15. 15.
    de Blaauw I, Winkelhorst JT, Rieu PN, van der Staak FH, Wijnen MH, Severijnen RS, van Vugt AB, Wijnen RM. Pancreatic injury in children: good outcome of nonoperative treatment. J Pediatr Surg. 2008;43(9):1640–3.CrossRefPubMedGoogle Scholar
  16. 16.
    Abbo O, Lemandat A, Reina N, Bouali O, Ballouhey Q, Carfagna L, Lemasson F, Harper L, Sauvat F, Galinier P. Conservative management of blunt pancreatic trauma in children: a single center experience. Eur J Pediatr Surg. 2013;23(6):470–3.CrossRefPubMedGoogle Scholar
  17. 17.
    Cigdem MK, Senturk S, Onen A, Siga M, Akay H, Otcu S. Nonoperative management of pancreatic injuries in pediatric patients. Surg Today. 2011;41(5):655–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Jurić I, Pogorelić Z, Biocić M, Todorić D, Furlan D, Susnjar T. Management of blunt pancreatic trauma in children. Surg Today. 2009;39(2):115–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Clark W, Paidas CN, Germain D, Guidi C, Pinkas H, Kayton ML. Delayed presentation of complete pancreatic ductal transection in children: management of two cases without resection. Pediatr Surg Int. 2013;29:401–5.CrossRefPubMedGoogle Scholar
  20. 20.
    Klin B, Abu-Kishk I, Jeroukhimov I, Efrati Y, Kozer E, Broide E, Brachman Y, Copel L, Scapa E, Eshel G, Lotan G. Blunt pancreatic trauma in children. Surg Today. 2011;41(7):946–54.CrossRefPubMedGoogle Scholar
  21. 21.
    Kawahara I, Maeda K, Ono S, Kawashima H, Deie R, Yanagisawa S, Baba K, Usui Y, Tsuji Y, Fukuta A, Sekine S. Surgical reconstruction and endoscopic pancreatic stent for traumatic pancreatic duct disruption. Pediatr Surg Int. 2014;30:951–6.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Surgery and Pediatrics, Pritzker School of MedicineThe University of ChicagoChicagoUSA

Personalised recommendations