Management of Traumatic Pancreatic Pseudocysts in Children

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2013 Sep 24

PMID 24057707

Authors

Y Ohno

H Ohgami

A Nagasaki

R Hirose

Affiliations

Soon will be listed here.

Abstract

Eight children with pancreatic injuries after blunt abdominal trauma are presented. One patient with pancreatitis without complications was treated successfully with medication; seven (87.5%) developed pseudocysts, which resolved spontaneously with conservative treatment in four cases (57.1%). Non-resolving pseudocysts in 3 patients finally required surgical intervention. Pseudocysts that resolve spontaneously and those that require surgical intervention can be distinguished. The two groups showed different time sequences in both serum amylase values and pseudocyst size. Analyses of these clinical data revealed three factors with significant predictive value. On the basis of these findings, a new management strategy for traumatic pancreatic pseudocysts in children is proposed. The cyst is likely to resolve spontaneously in cases showing any two or more of the following factors: (1) cyst presentation after day 6; (2) maximum serum amylase below 1,600 IU/l; and (3) serum amylase below 600 IU/l on day 20. However, early surgical intervention is required in the presence of two or more of the following: (1) cyst presentation before day 4; (2) maximum serum amylase above 1,900 IU/l; or (3) serum amylase above 1,200 IU/l on day 20.

References

Becmeur F, Dhaoui R, Rousseau P, Heintz C, Leculee R, Bientz J . Post-traumatic pancreatic pseudocyst: non-operative conservative management--report on 3 cases. Eur J Pediatr Surg. 1993; 3(5):302-5. DOI: 10.1055/s-2008-1066034. View

Graham J, Pokorny W, Mattox K, JORDAN Jr G . Surgical management of acute pancreatic injuries in children. J Pediatr Surg. 1978; 13(6D):693-7. DOI: 10.1016/s0022-3468(78)80116-x. View

Gorenstein A, OHalpin D, Wesson D, Daneman A, FILLER R . Blunt injury to the pancreas in children: selective management based on ultrasound. J Pediatr Surg. 1987; 22(12):1110-6. DOI: 10.1016/s0022-3468(87)80719-4. View

Smith S, Nakayama D, Gantt N, Lloyd D, Rowe M . Pancreatic injuries in childhood due to blunt trauma. J Pediatr Surg. 1988; 23(7):610-4. DOI: 10.1016/s0022-3468(88)80628-6. View

Dahman B, STEPHENS C . Pseudocysts of the pancreas after blunt abdominal trauma in children. J Pediatr Surg. 1981; 16(1):17-21. DOI: 10.1016/s0022-3468(81)80108-x. View

Sivit C, Eichelberger M, Taylor G, Bulas D, Gotschall C, Kushner D . Blunt pancreatic trauma in children: CT diagnosis. AJR Am J Roentgenol. 1992; 158(5):1097-100. DOI: 10.2214/ajr.158.5.1566674. View

Jeffrey Jr R, Federle M, Crass R . Computed tomography of pancreatic trauma. Radiology. 1983; 147(2):491-4. DOI: 10.1148/radiology.147.2.6836127. View

Robey E, Mullen J, Schwab C . Blunt transection of the pancrease treated by distal pancreatectomy, splenic salvage and hyperalimentation. Four cases and review of the literature. Ann Surg. 1982; 196(6):695-9. PMC: 1352987. DOI: 10.1097/00000658-198212001-00014. View

Sukul K, Lont H, Johannes E . Management of pancreatic injuries. Hepatogastroenterology. 1992; 39(5):447-50. View

10.

Ohno Y, Ohgami H, Nagasaki A, Hirose R . Complete disruption of the main pancreatic duct: a case successfully managed by percutaneous drainage. J Pediatr Surg. 1995; 30(12):1741-2. DOI: 10.1016/0022-3468(95)90470-0. View

11.

Bass J, Di Lorenzo M, DESJARDINS J, Grignon A, Ouimet A . Blunt pancreatic injuries in children: the role of percutaneous external drainage in the treatment of pancreatic pseudocysts. J Pediatr Surg. 1988; 23(8):721-4. DOI: 10.1016/s0022-3468(88)80410-x. View

12.

Vane D, Grosfeld J, West K, Rescorla F . Pancreatic disorders in infancy and childhood: experience with 92 cases. J Pediatr Surg. 1989; 24(8):771-6. DOI: 10.1016/s0022-3468(89)80534-2. View

13.

Grosfeld J, Rescorla F, West K, Vane D . Gastrointestinal injuries in childhood: analysis of 53 patients. J Pediatr Surg. 1989; 24(6):580-3. DOI: 10.1016/s0022-3468(89)80511-1. View

14.

Bass D, Lakhoo K . Pancreatic injuries in children. S Afr J Surg. 1991; 29(2):39-40. View

15.

Ford E, Hardin Jr W, Mahour G, Woolley M . Pseudocysts of the pancreas in children. Am Surg. 1990; 56(6):384-7. View

16.

Roche B, Bugmann P, Le Coultre C . Blunt injuries to liver, spleen, kidney and pancreas in pediatric patients. Eur J Pediatr Surg. 1992; 2(3):154-6. DOI: 10.1055/s-2008-1063428. View

17.

Gothi R, Bose N, Kumar N . Case report: ultrasound demonstration of traumatic fracture of the pancreas with pancreatic duct disruption. Clin Radiol. 1993; 47(6):434-5. DOI: 10.1016/s0009-9260(05)81069-4. View