Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children

Purpose: The treatment of complete pancreatic transection (CPT) from blunt trauma remains controversial. To determine the natural history and long-ter m outcome of nonoperative management of CPT, we analyzed all such patients over the last 10 years at a level I trauma center. Methods: Retrospective analysis between 1990 and 1999 was performed on 10 c onsecutive patients. Complete records were available for 9 patients. Data p ertaining to their trauma admission, plus long-term radiologic and clinical outcome were analyzed. Results: There were 6 boys and 3 girls with a median age of 8 years (range, 4 to 16 years) and a median injury severity score (ISS) of 25. All patient s displayed CPT on admission computed tomography (CT) scan. Four patients ( 44%) had associated intraabdominal injuries, but only 2 were significant. A ll patients were treated nonoperatively. Four patients (44%) had pseudocyst s, and 3 required percutaneous drainage. Other complications included a sin gle drainage of subphrenic collection, 1 inadvertent removal of drainage ca theter, and 2 cases of line sepsis. The duration of percutaneous drainage w as 14 to 60 days. The median length of hospitalization was 24 days (range, 6 to 52 days). After median follow up of 47 months, no patients showed exoc rine or endocrine insufficiency. One patient had abdominal pain not related to the pancreatic injury. Follow-up abdominal CT scans in 8 of 9 patients showed complete atrophy of the body and tail in 6 patients and 2 completely normal glands. Conclusions: Pancreatic transection is rare and commonly is found in isolat ion of other major abdominal injuries. No patients required surgery for the ir pancreatic transection. Pseudocysts can be managed effectively with perc utaneous drainage. After a median follow-up of 47 months, no patients had e ndocrine or exocrine dysfunction. Anatomically, the distal body and tail us ually atrophies; however, occasionally, the gland can heal and appear to re canalize. To the authors' knowledge, this is the first report to show the e ffectiveness of nonoperative management after complete pancreatic transecti on. J Pediatr Surg 36:823-827 Copyright (C) 2001 by W.B. Saunders Company.