Selective management of pediatric pancreatic injuries

Background: Despite trauma being the most common cause of pediatric pancrea titis, the diagnosis and management is often difficult. Methods: The hospital course, diagnostic and surgical procedures, and compl ications for all children with traumatic pancreatitis evaluated at a Region al Level I Trauma Center were reviewed retrospectively. Results: Twelve of 3,500 children (0.35%, mean age, 8.7 +/- 1.2 years) were reviewed. Intraoperative diagnosis was made in three after penetrating tra uma. Nine children sustained blunt pancreatic trauma (BPT) with serial radi ographic imaging confirming the diagnosis in seven. Serial serum amylase le vels, when performed, were normal in two and elevated in six, hut did not p redict injury severity or need for further intervention. Endoscopic retrogr ade cholangiopancreatography was performed in three children and indicated the need for surgical Intervention in two and prevented planned laparotomy in one. Two children underwent computed tomography-guided fluid drainage. P seudocysts developed in five children. Mortality rate from penetrating inju ries was 66% with no deaths from BPT. Conclusions: A combination of serial radiographic, laboratory, and ERCP fin dings will improve the diagnosis and management of BPT. Penetrating or main ductal injuries require surgical intervention, and fluid collections may r equire drainage, but, otherwise, most BPT can be managed nonoperatively wit h minimal morbidity and mortality. J Pediatr Surg 34:1142-1147. Copyright ( C) 1999 by W.B. Saunders Company.