Isolated Pancreatic Tail Injury in Paediatrics; A Case Report and Literature Review

Abstract

Pancreatic injury in paediatrics is a rare condition and can be difficult to diagnose. The diagnostic challenge is due to its symptom of vague abdominal pain which usually results in late presentation. Elevated biochemical markers such as amylase and lipase can aid in the evaluation of pancreatic injury, however, it is not specific and is only evident after several hours of trauma. Ultrasound is commonly used as a primary modality to evaluate abdominal organ injuries, but its role in detecting pancreatic injury is limited due to low sensitivity. High index of suspicion is needed to avoid undiagnosed pancreatic injury which could be lethal to children. We herein report a case of delayed presentation of isolated pancreatic tail injury in a child who was sufficiently diagnosed with ultrasound and treated conservatively. Proper initial assessment and diagnosis will allow appropriate management of pancreatic injury. Conservative management should include serial imaging to look at the evolution of pancreatic injury and detect complications such as pseudocyst or abscess formation.

Keywords: Malaysia; Paediatrics; Pancreatic injury; Pancreatic trauma.

Fig. 1

Transabdominal ultrasound mid axial plane at supraumbilical region showing homogenous mild hyperechoic appearance of pancreas which is normal for age and no evidence of laceration in the visualised neck and body of pancreas. The tail of pancreas is not visualised due to bowel gas obscuration. No peripancreatic free fluid. The rest of abdominal organs are unremarkable (not shown). AO: abdominal aorta, B: bowel, SV: splenic vein, PV: portal vein, IVC: intrahepatic inferior vena cava, BOP: neck and body of pancreas

Fig. 2

Transabdominal ultrasound midsagittal plane showing normal body and head of pancreas. SV: splenic vein, AO: abdominal aorta, SMA: superior mesenteric artery, IVC: inferior vena cava.