Management of blunt pancreatic injury in children

Background and Methods: Controversy persists regarding the management of pa ncreatic transection. Over the past 10 years, 51 patients admitted to the C hildren's Hospital of Pittsburgh sustained blunt pancreatic injuries. We re viewed their medical records to clarify the optimal management strategy and to define distinguishing characteristics, if any, of patients with pancrea tic transection. Results: Patients who sustained pancreatic transection had a significantly higher Injury Severity Score, length of stay., serum amylase, and serum lip ase, than those patients who sustained pancreatic contusion. Patients who u nderwent laparotomy within 48 hours of injury for pancreatic transection ha d a significantly shorter length of stay than those who underwent laparotom y more than 48 hours after injury. Conclusion: Serum amylase greater than 200 and serum lipase greater than 1, 800 may be useful clinical markers fur major pancreatic ductal injury when combined with physical examination, Early operative intervention for pancre atic transection results in shorter length of stay and fewer complications.