Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review
Blunt pancreatic injury (BPI) is relatively uncommon in children, and is associated with relatively high morbidity and mortality, especially if diagnosis is delayed. The aim of this report is to review the literature regarding controversial questions in the early diagnosis and management of pediatri...
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| Format: | Article |
| Language: | English |
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MDPI AG
2024-01-01
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| Series: | Children |
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| Online Access: | https://www.mdpi.com/2227-9067/11/1/135 |
| _version_ | 1797344344771919872 |
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| author | Igor Sukhotnik Neta Cohen |
| author_facet | Igor Sukhotnik Neta Cohen |
| author_sort | Igor Sukhotnik |
| collection | DOAJ |
| description | Blunt pancreatic injury (BPI) is relatively uncommon in children, and is associated with relatively high morbidity and mortality, especially if diagnosis is delayed. The aim of this report is to review the literature regarding controversial questions in the early diagnosis and management of pediatric BPI. A representative case of blunt pancreatic trauma in a six-year-old girl with delayed diagnosis and intraoperative and postoperative complications was described. A systematic search of databases and the grey literature in Scopus and Web of Science using relevant keywords was conducted. A total of 26 relevant articles published in last 5 years were found in PubMed. Although early CT performance is considered part of initial pancreatic trauma workup, the sensitivity of CT for detecting main pancreatic duct injuries in children is relatively low. MRCP and ERCP (if available) are useful for assessing ductal injury and should be performed when the status of the pancreatic duct is unclear on the CT. Most patients with low-grade pancreatic damage may be treated conservatively. Although surgery involving distal pancreatectomy remains the preferred approach for most children with high-grade pancreatic injury, there is growing evidence to suggest that non-operative management (NOM) is safe and effective. Most pancreatic pseudo cysts following NOM had relatively mild complications, and most resolved spontaneously. For those children who do require surgery, a conservative operative approach with the least risk is advocated. In conclusion, the optimal management for pediatric pancreatic trauma is controversial. Further clinical trials are required to generate clinical practice guidelines on pancreatic trauma in a child population. |
| first_indexed | 2024-03-08T11:00:59Z |
| format | Article |
| id | doaj.art-427827018bcd431b884eb0f7e0e51341 |
| institution | Directory Open Access Journal |
| issn | 2227-9067 |
| language | English |
| last_indexed | 2024-03-08T11:00:59Z |
| publishDate | 2024-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Children |
| spelling | doaj.art-427827018bcd431b884eb0f7e0e513412024-01-26T15:50:11ZengMDPI AGChildren2227-90672024-01-0111113510.3390/children11010135Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature ReviewIgor Sukhotnik0Neta Cohen1Department of Pediatric Surgery, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel Aviv 69978, IsraelPediatric Emergency Department, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Faculty of Medicine, Tel-Aviv University, Tel-Aviv 64239, IsraelBlunt pancreatic injury (BPI) is relatively uncommon in children, and is associated with relatively high morbidity and mortality, especially if diagnosis is delayed. The aim of this report is to review the literature regarding controversial questions in the early diagnosis and management of pediatric BPI. A representative case of blunt pancreatic trauma in a six-year-old girl with delayed diagnosis and intraoperative and postoperative complications was described. A systematic search of databases and the grey literature in Scopus and Web of Science using relevant keywords was conducted. A total of 26 relevant articles published in last 5 years were found in PubMed. Although early CT performance is considered part of initial pancreatic trauma workup, the sensitivity of CT for detecting main pancreatic duct injuries in children is relatively low. MRCP and ERCP (if available) are useful for assessing ductal injury and should be performed when the status of the pancreatic duct is unclear on the CT. Most patients with low-grade pancreatic damage may be treated conservatively. Although surgery involving distal pancreatectomy remains the preferred approach for most children with high-grade pancreatic injury, there is growing evidence to suggest that non-operative management (NOM) is safe and effective. Most pancreatic pseudo cysts following NOM had relatively mild complications, and most resolved spontaneously. For those children who do require surgery, a conservative operative approach with the least risk is advocated. In conclusion, the optimal management for pediatric pancreatic trauma is controversial. Further clinical trials are required to generate clinical practice guidelines on pancreatic trauma in a child population.https://www.mdpi.com/2227-9067/11/1/135pancreatic traumachildrennon-operative managementdiagnosismain duct injurypancreatectomy |
| spellingShingle | Igor Sukhotnik Neta Cohen Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review Children pancreatic trauma children non-operative management diagnosis main duct injury pancreatectomy |
| title | Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review |
| title_full | Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review |
| title_fullStr | Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review |
| title_full_unstemmed | Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review |
| title_short | Management of Blunt Pancreatic Trauma in Children: A Persistent Controversy—Case Report and Comprehensive Literature Review |
| title_sort | management of blunt pancreatic trauma in children a persistent controversy case report and comprehensive literature review |
| topic | pancreatic trauma children non-operative management diagnosis main duct injury pancreatectomy |
| url | https://www.mdpi.com/2227-9067/11/1/135 |
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