title: Conservative management of blunt pancreatic trauma in children: a single center experience.
abstract: BACKGROUND
  Blunt trauma of the pancreas represents a significant part of abdomen trauma in children with an incidence estimated at around 10%. If the conservative management is widely accepted concerning the stages I and II, it remains controversial concerning stages III and IV. The aim of our study was to perform a descriptive analysis of the nonoperative management, with a focus on the occurrence of pseudocysts.
  
  
  METHODS
  The charts of the patients treated in our center for pancreatic trauma from 1990 to 2010 have been reviewed. It was defined by an initial lipase greater than three times the norm and an abnormal computed tomography scan.
  
  
  RESULTS
  A total of 36 patients were included, with 26 boys (72%) and 10 girls (28%) with an average age of 8.7 years. The trauma was isolated in 13 cases (36.1%) and in 23 cases, there were other associated lesions (mainly liver [n = 9] and spleen [n = 5]). Pancreatic injuries were graded as follows: I (n = 21), II (n = 2), III (n = 7), and IV (n = 6). Pseudocysts occurred in 11 patients (30.5%) mainly in grades III (n = 3) and IV (n = 7), with an average delay of 17 days. Initial management of pseudocysts was conservative in six patients (54.6%), whereas five patients required mini-invasive procedures.
  
  
  CONCLUSIONS
  Nonoperative management remains a safe way to treat pancreatic injuries despite an average 30% rate of pseudocyst (PC) appearance. It allows a reduction in the number of children who required procedures to less than half of the patients where PC occurred. Furthermore, these procedures were exclusively mini-invasive.
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Olivier
authors: O
authors: Abbo
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Aurélie
authors: A
authors: Lemandat
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Nicolas
authors: N
authors: Reina
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Ourdia
authors: O
authors: Bouali
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Quentin
authors: Q
authors: Ballouhey
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Luana
authors: L
authors: Carfagna
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Frederique
authors: F
authors: Lemasson
authors: Department of Pediatric Surgery, CHU Felix Guyon, Saint Denis, Réunion, France.
authors: Luke
authors: L
authors: Harper
authors: Department of Pediatric Surgery, CHU Felix Guyon, Saint Denis, Réunion, France.
authors: Frederique
authors: F
authors: Sauvat
authors: Department of Pediatric Surgery, Children's Hospital CHU Toulouse, France.
authors: Philippe
authors: P
authors: Galinier
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008049:Lipase / Q000032:analysis; D008297:Male; D010179:Pancreas / Q000293:injuries* / Q000473:pathology; D010192:Pancreatic Pseudocyst / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000628:therapy*
chemical_list: D008049:Lipase