Nonoperative management of blunt pancreatic injury in childhood

Purpose: Nonoperative management for blunt pancreatic injury in children wa s performed between 1977 and 1998. The efficiency and safety of nonoperativ e management was examined. Methods: Pancreatic injury was diagnosed in 20 children. The surgical indic ation was determined by hemodynamic instability and the management of assoc iated injuries. Children without surgical indications were treated initiall y by nonoperative management. Results: Nineteen of 20 children were treated initially nonoperatively, and 18 of the 19 survived. Surgical exploration was performed in only 1 child with perforation of the duodenum and bile duct. One child died of complicat ions of total parenteral nutrition. Ultrasound scan and computed tomography scan showed pancreatic contusion in 9, laceration in 6, and injury of the main pancreatic duct (MPD) in 5. Pseudocysts were detected in 10 (5 lacerat ion and 5 MPD injury). Pseudocysts smaller than 10 cm disappeared after non operative management, and those larger than 10 cm required operative manage ment. Rupture of pseudocysts occurred in 2 children by rotating the upper t orso. Conclusions: Nonoperative management of pancreatic injuries is effective in children, although careful management is required to avoid complications. Pseudocysts smaller than 10 cm were treated successfully by nonoperative ma nagement, and those larger than 10 cm required surgical management. Copyrig ht (C) 1999 by W.B. Saunders Company.