title: Management of blunt pancreatic trauma in children.
abstract: OBJECTIVE
  Blunt abdominal trauma is the major cause of abdominal injury in children. Because of the retroperitoneal location, insidious signs and symptoms and the lack of sensitivity with common imaging modalities often lead to difficulties in making an accurate diagnosis. The most common complication is the formation of a pancreatic fistula, pancreatitis and a pancreatic pseudocyst, which usually manifests within 3 or 4 weeks after injury.
  
  
  METHODS
  The case records of seven children (4 male, 3 female) treated for blunt pancreatic injury in the department of pediatric surgery, University Hospital, Split were reviewed.
  
  
  RESULTS
  The treatment modalities were selected according to the grade of the pancreatic injury, hemodynamic status and associated injuries. Because all of the patients were classified as grade I or II according to the American Association for the Surgery of Trauma (AAST) classification, a conservative treatment was selected for all seven patients. In four patients the conservative treatment resulted in the total regression of the clinical, biochemical and radiological signs within four weeks (AAST grade I). In the other three patients, pancreatic pseudocysts arose within 3 or 4 weeks after the injury (AAST grade II).
  
  
  CONCLUSIONS
  The status of the main pancreatic duct and the location of the pancreatic injury constitute the basis of the AAST scoring system. This scale should be used as a guide to selecting a surgical or conservative strategy. Based on these data, two factors appear to be the most important determinants of the treatment strategy for children with pancreatic injury: the grade of the pancreatic injury, which is determined according to the status of the main pancreatic duct and the clinical status of the patient.
authors.affiliation: Department of Pediatric Surgery, University Hospital Split, Spincićeva 1, 21000, Split, Croatia.
authors.forename: Ivo
authors.initials: I
authors.lastname: Jurić
authors.forename: Zenon
authors.initials: Z
authors.lastname: Pogorelić
authors.forename: Mihovil
authors.initials: M
authors.lastname: Biocić
authors.forename: Davor
authors.initials: D
authors.lastname: Todorić
authors.forename: Dubravko
authors.initials: D
authors.lastname: Furlan
authors.forename: Tomislav
authors.initials: T
authors.lastname: Susnjar
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000628:therapy*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000293:injuries*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*