Pancreatic trauma in children.
OBJECTIVE
To document the demographics, mechanisms and outcome of traumatic pancreatitis in children at a single large tertiary referral centre in Australia.


METHODS
We undertook a 10-year retrospective audit of children admitted to the Royal Children's Hospital, Melbourne, Australia with a hospital coded diagnosis which included pancreatic injury between 1993 and 2002. Data included patient demographics, source of admission, mechanism of injury, pancreatic complications, associated injuries, intensive care unit admission, results of any operative findings, results of any acute computed tomography and/or ultrasound imaging of pancreas, selected laboratory findings and length of stay.


RESULTS
We identified two distinct groups of patients in the 91 documented cases of pancreatic trauma (median age 8.0 years, range 0.6-15.8 years; M:F 2.5:1.0): 59 had a history of abdominal trauma and elevated serum lipase but no CT or ultrasound evidence of pancreatic injury (Group A); 32 had a history of abdominal trauma, elevated serum lipase but also had CT scan and/or ultrasound evidence of pancreatic injury (Group B). Patients with "less severe" injury based on normal imaging had a lower initial lipase level [Group A, median 651 U/L (interquartile range 520-1,324) vs. Group B, 1,608 U/L (interquartile range 680-3,526); p = 0.005] and shorter admission time [Group A, 9.0 days (interquartile range 5.5-15.5) vs. Group B, 13.4 days (interquartile range 6.8-23.8); p = 0.04]. There were no differences with respect to mortality (Group A, 13.5% vs. Group B, 12.5%), but patients with evidence of injury on imaging were more likely to have surgical intervention (p = 0.0001). The single most important overall cause of pancreatic trauma was involvement in a motor vehicle accident as a passenger or pedestrian. However, in children with high-grade ductal injury, bicycle handlebar injuries were most common. Associated injuries were common in both groups.


CONCLUSIONS
Significant pancreatic injury can occur in the absence of abnormality on medical imaging. Pancreatic trauma commonly occurs in the context of multiple injuries after motor vehicle accidents in children and bicycle handlebar injuries, especially in boys. Most children can be treated conservatively, with surgical intervention being limited to high-grade ductal injury.
Sutherland
Ingrid
I
Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne, Australia.
Ledder
Oren
O
Crameri
Joe
J
Nydegger
Andrew
A
Catto-Smith
Anthony
A
Cain
Timothy
T
Oliver
Mark
M
D000007:Abdominal Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000293:Adolescent; D001642:Bicycling; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood; D008297:Male; D009104:Multiple Trauma / Q000453:epidemiology; D010179:Pancreas / Q000293:injuries*; D012189:Retrospective Studies; D014739:Victoria / Q000453:epidemiology
D008049:Lipase
Ann Chir. 2001 Dec;126(10):992-5
11803637
J Pediatr Surg. 1998 Feb;33(2):343-9
9498414
Eur J Radiol. 2006 Jul;59(1):3-7
16781837
J Clin Gastroenterol. 2002 Apr;34(4):459-62
11907364
J Trauma. 1990 Nov;30(11):1427-9
2231822
Am J Surg. 1988 Sep;156(3 Pt 1):201-5
3048135
J Trauma. 1991 Dec;31(12):1600-6
1749029
Clin Pediatr (Phila). 1990 Nov;29(11):667-8
2265519
J Trauma. 2005 Dec;59(6):1309-13
16394902
Singapore Med J. 2003 Sep;44(9):453-6
14740774
Am Surg. 2002 Aug;68(8):704-7; discussion 707-8
12206605
Am Surg. 1997 Jul;63(7):598-604
9202533
Dig Surg. 2002;19(4):291-7; discussion 297-9
12207073
Injury. 2006 Dec;37(12):1143-56
17092502
World J Surg. 2006 Dec;30(12):2136-41
17102912
J Trauma. 2003 Nov;55(5):898-905
14608163
J Trauma. 2004 Apr;56(4):774-8
15187740
J Pediatr Surg. 1999 May;34(5):818-23; discussion 823-4
10359187
Accid Anal Prev. 2006 Jan;38(1):122-7
16139232
Injury. 2001 Dec;32(10):753-9
11754881
Pediatr Clin North Am. 1996 Feb;43(1):125-56
8596678
J Trauma. 1997 Jan;42(1):49-53
9003257
Nutr Clin Pract. 2004 Feb;19(1):16-24
16215092
J Pediatr Surg. 2007 Feb;42(2):340-4
17270545
J Pediatr Surg. 2004 Jan;39(1):96-9
14694381
Am J Med. 1992 Mar;92(3):239-42
1372152
Clin Chim Acta. 1990 Mar 15;187(3):243-54
2323064