Minimally Invasive Approaches for Traumatic Rupture of the Pancreas in Children-A Case Series

Abstract

Pancreatic trauma in children is rare; therefore, both scientific knowledge and clinical experience regarding its management are limited. Abdominal sonography and subsequent computed tomography (CT) imaging are the diagnostic mainstay after severe abdominal trauma in many pediatric trauma centers. However, the diagnosis of pancreatic injury is missed on the initial imaging in approximately one third of cases, with even higher numbers in young children. While conservative treatment is preferred in low-grade injuries, surgical interventions may be indicated in more severe injuries. We present a case series including four patients with high-grade pancreatic injury. Two patients were treated surgically with open laparotomy and primary suture of the head of the pancreas and pancreatico-enterostomy, one patient underwent endoscopic stenting of the pancreatic duct and one received conservative management including observation and secondary endoscopic treatment. We want to emphasize the fact that using a minimally invasive approach can be a feasible option in high-grade pancreatic injury in selected cases. Therefore, we advocate the necessity of fully staffed and equipped high-level pediatric trauma centers.

Keywords: abdominal trauma; children; organ laceration; pancreatic injury; pediatric.

Figure 1

Complete rupture in the middle of the pancreas.

Figure 2

ERCP demonstrating the rupture of the pancreatic duct with paravasation of contrast dye (A). Stent placement (B).

Figure 3

Major duodenal papilla leaking bile (A). Application of contrast dye into the principal pancreatic duct (B). Stent with multiple perforation in place (C).

Figure 4

Transgastric endosonography showing a retention at the site of rupture (A). Transgastric placement of a pigtail drain (B).

Figure 5

Follow-up ERCP after almost 6 months showing an intact principal pancreatic duct.