Nonoperative management of blunt pancreatic injury in childhood.
OBJECTIVE
Nonoperative management for blunt pancreatic injury in children was performed between 1977 and 1998. The efficiency and safety of nonoperative management was examined.


METHODS
Pancreatic injury was diagnosed in 20 children. The surgical indication was determined by hemodynamic instability and the management of associated injuries. Children without surgical indications were treated initially by nonoperative management.


RESULTS
Nineteen of 20 children were treated initially nonoperatively, and 18 of the 19 survived. Surgical exploration was performed in only 1 child with perforation of the duodenum and bile duct. One child died of complications of total parenteral nutrition. Ultrasound scan and computed tomography scan showed pancreatic contusion in 9, laceration in 6, and injury of the main pancreatic duct (MPD) in 5. Pseudocysts were detected in 10 (5 laceration and 5 MPD injury). Pseudocysts smaller than 10 cm disappeared after nonoperative management, and those larger than 10 cm required operative management. Rupture of pseudocysts occurred in 2 children by rotating the upper torso.


CONCLUSIONS
Nonoperative management of pancreatic injuries is effective in children, although careful management is required to avoid complications. Pseudocysts smaller than 10 cm were treated successfully by nonoperative management, and those larger than 10 cm required surgical management.
Kouchi
K
K
Department of Pediatric Surgery, School of Medicine, Chiba University, Japan.
Tanabe
M
M
Yoshida
H
H
Iwai
J
J
Matsunaga
T
T
Ohtsuka
Y
Y
Kuroda
H
H
Hishiki
T
T
Ohnuma
N
N
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D007564:Japan; D008297:Male; D010179:Pancreas / Q000293:injuries*; D015996:Survival Rate; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*