Citation Information :
Jaramillo-Escobar SL, Giraldo-Campillo D, Romero-Espitia WD. Experience in the Management of Complex Pancreatic Trauma in Pediatric Population. Panam J Trauma Crit Care Emerg Surg 2024; 13 (3):114-119.
Introduction: Pancreatic trauma in children accounts for only a small proportion (0.2–2%) of blunt abdominal trauma, with unique clinical and therapeutic implications. Main ductal involvement and hemodynamic stability are the main determinants in defining management. Despite its importance, the lack of solid evidence in the literature has made it difficult to develop effective and standardized treatment strategies for this age-group.
Methods: We present the results of a retrospective descriptive study that included 10 pediatric patients with complex pancreatic trauma attended between 2015 and 2024 in a referral hospital in Medellín. Most cases involved the main pancreatic duct. The clinical variables, interventions performed, complications, and main outcomes are described. Tomographic or intraoperative criteria were used to classify the severity of trauma. The variables analyzed were the following: mechanism of associated trauma, clinical characteristics, imaging findings, involvement or not of the pancreatic duct, and management performed. In addition, outcomes in terms of mortality, length of hospital stay, reoperation, collection, presence of pancreatic fistula, need for additional endoscopic or percutaneous procedures, and sequelae were evaluated.
Results: The age range was 19 months to 12 years. The mechanism of trauma was blunt in all cases. The cardinal symptoms were abdominal pain and vomiting. Diagnosis was made by tomography in eight cases and as a surgical finding in two cases. Most patients presented with grade III or IV trauma according to the American Association for the Surgery of Trauma (AAST) classification. Seven patients required surgical management, and three patients required endoscopic management. No inhospital mortality was noted. In five cases, there were pancreatic fistulae, one with collection, and two with pseudocysts.
Conclusion: The general condition and location of pancreatic grade lesions determine the management of pediatric patients with pancreatic trauma. Preserving as much pancreatic tissue as possible is essential for surgical resection.
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