Childhood pancreatic trauma: Clinical presentation, natural history and outcome.
Pancreatology
; 20(1): 68-73, 2020 Jan.
Article
en En
| MEDLINE
| ID: mdl-31706820
ABSTRACT
OBJECTIVES:
To study the presentation, management strategies and long-term natural history of children with pancreatic trauma.METHODS:
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).RESULTS:
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 [nâ¯=â¯18,50%]. Presenting features were abdominal pain [nâ¯=â¯26,72%], lump [nâ¯=â¯16, 44.4%], ascites [nâ¯=â¯13,36%], pleural effusion [nâ¯=â¯9,25%] and anasarca [nâ¯=â¯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 [nâ¯=â¯17,47.2%], TPN [nâ¯=â¯5,13.8%], octreotide [nâ¯=â¯13,36%], pseudocyst drainage [radiological (nâ¯=â¯18,50%), endoscopic (nâ¯=â¯3,8.3%)] and ERCP [nâ¯=â¯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.CONCLUSION:
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.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Páncreas
/
Heridas y Lesiones
Tipo de estudio:
Etiology_studies
Límite:
Child
/
Female
/
Humans
/
Male
Idioma:
En
Año:
2020
Tipo del documento:
Article