Management of pancreatic and duodenal injuries in pediatric patients.
Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP). The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal injuries often need surgical treatment.
Plancq
M C
MC
Department of Pediatric Surgery, University Hospital of Amiens, 80054 Amiens, France.
Villamizar
J
J
Ricard
J
J
Canarelli
J P
JP
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004386:Duodenum / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007813:Laparotomy / Q000379:methods; D008297:Male; D010179:Pancreas / Q000293:injuries / Q000601:surgery*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000601:surgery