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Severe pancreatic trauma in children

M Hamzy, A Engelis,K Schaarschmidt, P Laizans, J Sveklis, T Sarajeva, JP Canarelli

CHU Amiens, France

 

ABSTRACT

Introduction: The management of pancreatic trauma in children remains controversial, with a prominent place of conservative treatment due to more efficient imagery. The aim of this retrospective multicentre study is to compare the management in 3 European centres (Amiens, Berlin, Riga).

Material and methods: We report 40 patients with severe pancreatic trauma that caused pancreatic duct rupture, over a 12-year period. The diagnostic management included: clinical examination, blood tests, imaging US, CT, MRCP and ERCP (endoscopic retrograde cho- langiopancreatography). The non-operative management consisted of total parenteral nutrition in all three centres and when the patient’s condition allowed, a constant rate enteral nutrition by naso-jejunal tube, analgesic medication, sometimes with epidural anaesthesia in some ca- ses, anti-H2, antibiotic therapy in case of septic complications and somatostatin. The surgical ma- nagement was reserved for these complications: pancreatic pseudocyst, necrosis and pancreatic abscess. The treatment was laparotomy and external drainage (Riga) or CT-guided external drainage (Berlin) and internal drainage after ERCP with a cysto-gastric drain placed by endoscopy (Amiens). results: In this series of 40 patients with severe pancreatic trauma we report 25 pancreatic pseudocysts; among these, 18 had external drainage, 2 had pancreatic duct rupture treated by ERCP and stent placement, 2 cases of spontaneous resolution of the pseudocyst and 3 cases of transgastric internal drainage (Amiens). Two deaths are reported: in one case due to sepsis and in the other due to neurological complications in the context of multiple trauma (Riga). The long-term follow-up revealed one case of pancreatic fibrosis.

Conclusion: The conservative management including jejunal nutrition proved its effectiveness; ERCP is the method of choice in cases of ductal lesion with internal drainage or, if not possible, external drainage under CT.

 

Key words: pancreatic trauma, pancreatic pseudocyst