NONOPERATIVE MANAGEMENT OF PANCREATIC INJURIES IN CHILDREN

Purpose: The safety and efficacy of nonoperative management of pancrea tic contusions and transections was examined by reviewing the case his tories of 35 consecutive children with pancreatic injuries treated ove r the past 10 years. Methods/Results: Surgical exploration was perform ed for the management of associated injuries only. The diagnosis of pa ncreatic trauma was suspected in children with abdominal pain, tendern ess, elevated serum amylase levels and findings consistent with pancre atic injury on abdominal ultrasound scan or computerized tomography (C T) examination. After children were diagnosed with pancreatic injury, enteral feedings were withheld and total parenteral nutrition administ ered until abdominal pain resolved and serum amylase levels and radiog raphic findings improved. Twenty-three children received diagnosis wit hin 24 hours of injury, and in 12, the diagnosis was delayed 2 to 14 d ays. Hyperamylasemia was found in 27 of 35 children. Twenty-eight chil dren sustaining pancreatic injuries were treated nonoperatively. Abdom inal imaging in these children demonstrated pancreatic contusion in 14 , transection in 11, and pseudocyst in three. Enteral feeding resumed an average of 15 days after injury. The average hospital stay was 21 d ays. Pseudocysts formed in 10 children (2 of 14 with contusion; 5 of 1 1 with transection; three children presented late, and the type of pan creatic injury could not be determined), whose average hospital stay w as 25 days. All pseudocysts were successfully managed nonoperatively, although percutaneous aspiration or drainage was required in six child ren. Children underwent follow-up for an average of 10 months after in jury (range, 1 to 144 months). Abdominal pain and radiological abnorma lities resolved in all children before discharge from the clinic. Conc lusions: Nonoperative management of pancreatic contusion and transecti on diagnosed radiologically is effective and safe. Pseudocysts may for m after pancreatic injury, and if large or symptomatic, can be managed successfully by percutaneous drainage. Copyright (C) 1998 by W.B. Sau nders Company.