Management of pancreatic and duodenal injuries in pediatric patients

Diagnosis of duodenal and pancreatic injuries is frequently delayed, and op timal treatment is often controversial. Fourteen children with duodenal and /or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duode nal injury was present in 4. The preoperative diagnosis wats suspected in o nly 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical mana gement. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreati c resection without splenectomy. A duodenal resection with reconstruction b y duodeno-duodenostomy was performed in 1 case. The overall complication ra te was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was r ecognized 3 days after the initial laparotomy by endoscopic retrograde chol angiopancreatography (ERCP). The mortality was 7%; 1 patient died from sept ic and neurologic complications. When the diagnosis of pancreatic ductal in juries is a major problem, ERCP may be a useful diagnostic procedure. Pancr eatic injuries without a transected duct may often be treated conservativel y. The surgical or conservative management of duodenal hematomas is still c ontroversial; other duodenal injuries often need surgical treatment.