Management of blunt pancreatic injuries in children

Background: Most blunt abdominal injuries of solid organs in children can be managed nonoperatively. To date, however, there has been no general agreement regarding the application of nonoperative management to pancreatic injuries. Objective: We evaluated the course of patients who underwent blunt pancreatic trauma and were managed nonoperatively, in order to determine the efficacy and safety of this strategy. Patients and Methods: A retrospective study of 26 patients with blunt pancreatic injury admitted to the Department of Pediatric Surgery at the Soroka Medical Center between 1983 and 2002 was conducted. The data was collected from the Trauma Registry and the medical records. The results were analyzed using Fisher's exact test for comparison of proportions and Student's t-test for comparison of means. Level of confidence was defined at p < 0.05. Results: We identified 26 children with blunt pancreatic injuries. 19 patients sustained a minor injury, and seven had a major injury with transection of the main pancreatic duct. All 19 patients considered to have a minor injury, including three in whom pseudocysts were formed, responded well to nonoperative management. Five of the seven patients who sustained a major injury required an interventional procedure. Conclusion: Most pediatric patients with blunt pancreatic trauma, including those with pseudocyst formation, respond well to supportive nonoperative management. Symptomatic patients due to a large pseudocyst or a pancreatic abscess can be managed successfully by percutaneous computerized tomographic scan-guided drainage; however, some of these patients may require operative intervention.