Traumatic pancreatic duct injury in children: minimally invasive approach to management.
BACKGROUND
The management of children with main pancreatic duct injuries is controversial. We report a series of patients with pancreatic trauma who were treated using minimally invasive techniques.


METHODS
Retrospective review of children with pancreatic trauma treated at a UK tertiary referral institution between 1999 and 2004.


RESULTS
Fifteen children (11 boys) were admitted with pancreatic trauma. Twelve (80%) were less than 50th centile for body weight. Contrast-enhanced computed tomography (CT) scans were used to define organ injury, supplemented by magnetic resonance cholangiopancreatography (MRCP) in 7. Twelve (80%) underwent diagnostic endoscopic retrograde cholangiopancreatography (ERCP) with a median time after injury of 11 (range, 6-29) days. The degree of pancreatic injury was defined by ERCP and CT/MRCP as grade II (n = 2), grade III (n = 4), grade IV (n = 9) (American Association for the Surgery of Trauma grades). Nine children had a transductal pancreatic stent inserted endoscopically. Computed tomography/ultrasound-guided drainage was performed in 4 children for acute fluid collections. Two children later underwent endoscopic cyst-gastrostomy, one of whom later required conversion to an open cyst-gastrostomy.


CONCLUSIONS
Body habitus may predispose to pancreatic duct trauma. Contrast-enhanced CT scan (and MRCP) should dictate the need for ERCP. Transductal pancreatic stenting allows internal drainage of peripancreatic collections and may reestablish duct continuity, although a proportion still requires percutaneous or endoscopic cyst-gastrostomy drainage. Open surgery for pancreatic trauma should now be an exception.
Houben
Christophe H
CH
Department of Pediatric Surgery, Kings College Hospital, Denmark Hill, SE5 9RS London, UK.
Ade-Ajayi
Niyi
N
Patel
Shailesh
S
Kane
Pauline
P
Karani
John
J
Devlin
John
J
Harrison
Philip
P
Davenport
Mark
M
D000293:Adolescent; D001835:Body Weight; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde; D049448:Cholangiopancreatography, Magnetic Resonance; D004322:Drainage; D016145:Endoscopy, Digestive System; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed