Pancreatic trauma in Scottish children

Background: Trauma is the leading cause of death in children, Abdominal tra uma is common, but there is little information on pancreatic injuries in UK children. The aim of this study was to investigate the clinical course of children suffering pancreatic trauma in Scotland, Methods: All children adm itted to the three major Scottish paediatric surgery centres with evidence of pancreatic injury were identified, A retrospective case note review of t hese children was performed using a structured proforma, Results: 16 patien ts (11 males and 5 females), median age 7 years (range 1 - 11 years) were i dentified. The commonest mechanism of injury was the typicall bicycle handl ebar injury (10/16, 62%), Delays in definitive diagnosis were common due to subtle clinical signs. Increased serum amylase levels upon admission were not necessarily diagnostic for pancreatic injury, The diagnosis was confirm ed by ultrasound scanning and/or computerised tomography in all patients, T en patients (62%) developed pseudocysts and, in seven cases, they settled w ith non-operative management. There were no deaths and no longterm complica tions, Conclusion: Pancreatic injury in children is rare, and a high index of suspicion is required to make the diagnosis. The commonest mechanism of injury is a direct impact to the epigastrium, typically the bicycle handleb ar injury, Presentation and diagnosis are frequently delayed. The incidence of pseudocysts is high, but most can be managed conservatively.