Operative vs nonoperative management of blunt pancreatic trauma in children.
OBJECTIVE
The aim of this study was to evaluate the outcome of nonoperative vs operative management of blunt pancreatic trauma in children.


METHODS
Retrospective review of pancreatic injuries from 1995 to 2006 at an urban level I regional pediatric trauma center.


RESULTS
Forty-three children with pancreatic injury were included in the analysis. Injuries included grade I (n = 18), grade II (n = 6), grade III (n = 17), and grade IV (n = 2). For grade II to IV injuries, patients managed operatively (n = 14) and nonoperatively (n = 11) had similar lengths of stay and rates of readmission, despite increased pancreatic complications (PCs) in the nonoperative cohort (21% vs 73%; P = .02). There was a trend toward increased non-PCs in patients managed with resection (P = .07). Twelve patients underwent successful diagnostic endoscopic retrograde cholangiopancreatography in which duct injury was identified. In this group, nonoperative management was pursued in 6 patients but was associated with increased rates of PC (86% nonoperative vs 29% operative; P = .02).


CONCLUSIONS
Operative management of children with grades II to IV pancreatic injury results in significantly decreased rates of PCs but fails to decrease length of stay in the hospital, possibly as a result of non-PCs. Endoscopic retrograde cholangiopancreatography may serve as a useful diagnostic modality for guiding operative vs nonoperative management decisions.
Department of Pediatric Surgery, The Children's Hospital, University of Colorado Health Science Center, Aurora, CO 80045, USA.
James H
JH
Wood
David A
DA
Partrick
Jennifer L
JL
Bruny
Angela
A
Sauaia
Steven L
SL
Moulton
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging; D010289:Parenteral Nutrition, Total / Q000379:methods; D011183:Postoperative Complications / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000145:classification / Q000628:therapy; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000601:surgery* / Q000628:therapy*