Distal pancreatectomy after pancreatic injury, in two pediatric patients. (2020)

• Record Type: Journal Article
• Authors: Hadjizacharias, Theodoros; Kaliviotis, Ioannis; Kottakis, George; Pavlides, Orestis; Papalouka, Dimitra; Polydorou, Andreas
• Is Part Of: International journal of surgery case reports. Volume 76(2020)
• Page Start: 293
• Page End: 296
• Publication Date: 2020
• Subjects: Case report -- Children -- Blunt abdomen trauma -- Pancreatic injury -- Pancreatic surgery -- Main pancreatic duct; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.10.008
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Blunt trauma to the abdomen, accounts for the majority of abdominal injuries in children. Pancreas injury from blunt abdominal trauma in children is very rare. The emergent use of ERCP in children has not been implement widely. Operative vs non-operative management of blunt pancreatic trauma in children. A key is the status of pancreatic duct. Abstract: Introduction: Although serious trauma is rare in pediatric patients, the management of blunt force trauma to the abdomen remains a challenge for Child Surgery Departments. Pancreatic injury comprises the fourth most common injury among the solid organs and cases accompanied by rupture of the main pancreatic duct (MPD) present a further challenge for physicians (Fayza Haider et al.; Wood et al., 2010; Jobst et al., 1999; Grosfeld et al., 2006). Case presentation: Two adolescents, both 13 years old, where referred to our Pediatric Hospital, due to blunt force abdominal trauma. During admission, both patients were hemodynamically stable, in good general condition but suffering from abdominal pain and vomiting. After a full diagnostic check-up, grade IV pancreatic injury was diagnosed in both patients and they were taken to the operation room 3 and 6 days post-injury. Intra-operatively a distal pancreatectomy along with splenectomy was performed in both cases, with catheterization and ligation of the main pancreatic duct. Both patients were admitted to the pediatric ICU for 2 and 4 days. Both made an uneventful recovery and remain well 6 months postoperatively. Conclusion: While hemodynamically stable, patients with Grade IV pancreatic injury, benefit from sub-acute management, allowing for planning of the surgical intervention. Distal pancreatectomy with splenectomy, along with catheterization and ligation of the main pancreatic duct, has excellent post-operative results. The chief of the Pediatric Hospital, said that in 35 years at pediatric surgery, is the first time with the need of operative management, in pancreatic injury. The hepatobiliary surgical expert in adults, who was consulted in both cases, said that without the surgeries, both children were going to die.