Surgical Treatment of Pancreatic Trauma in Children

Jae-Hyung Cho; Hyun-Young Kim; Sung-Eun Jung; Kwi-Won Park

doi:10.13029/jkaps.2013.19.2.98

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Surgical Treatment of Pancreatic Trauma in Children

Jae-Hyung Cho, M.D., Hyun-Young Kim, M.D., Sung-Eun Jung, M.D., Kwi-Won Park, M.D.

Journal of the Korean Association of Pediatric Surgeons 2013;19(2):98-107.
Published online: December 24, 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.98

Department of Pediatric Surgery, Seoul National University Children's Hospital, Seoul, Korea.

Correspondence: Hyun-Young Kim, M.D., Department of Pediatric Surgery, Seoul National University Children's Hospital, 101 Daehang-ro, Yeongeon-dong, Jongro-gu, Seoul 110-744, Korea. Tel: 02)2072-2478, Fax: 02)747-5130, spkhy02@snu.ac.kr

• Received: September 16, 2013 • Accepted: November 30, 2013

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ABSTRACT
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ABSTRACT

Debates exist about the appropriate treatment for pancreatic trauma in children. We intended to examine the safety of the operation of pancreatic trauma in children. This is a retrospective study of 13 patients, younger than 15, who underwent surgery for pancreatic trauma, between 1993 and 2011 in Seoul National University Children's Hospital. Medical records were reviewed for mechanism of trauma, clinical characteristics, radiological findings, operation and outcomes. Organ injury scaling from the AAST (American Association for Surgery of Trauma) was used. All injuries were caused by blunt trauma. Patients with grade III, IV, and those who were difficult to distinguish grade II from IV, underwent surgery due to severe peritonitis. Three patients with grade II were operated for reasons of mesenteric bleeding, tumor rupture of the pancreas, and progression of peritonitis. Distal pancreatectomy was performed in 10 patients and subtotal pancreatectomy and pylorus preserving pancreaticoduodenectomy in 1 patient each. The remaining one underwent surgical debridement because of severe adhesions. The location of injury, before and after operation, coincided in 83.3%. The degree of injury, before and after the operation, was identical in all the patients except for those who were difficult to tell apart grade II from grade IV, and those cannot be graded due to severe adhesion. Postoperative complications occurred in 23.1%, which improved with conservative treatment. Patients were discharged at mean postoperative 12(range 8~42) days. Even though patients with complications took longer in time from diagnosis to operation, time of trauma to operation and hospital stay, this difference was not significant. In conclusion, When pancreatic duct injury is present, or patient shows deterioration of clinical manifestation without evidence of definite duct injury, or trauma is accompanied by other organ injury or tumor rupture, operative management is advisable, and we believe it is a safe and feasible method of treatment.
Keywords: Pancreas; Trauma; Surgery; Child

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Table 1

AAST (American Association for the Surgery of Trauma) Classification

Table 2

Preoperative Clinical Findings and APACHE Score

Abbreviations: WBC; white blood cell, Hb; hemoglobin, CRP; C-reactive protein, BP; blood pressure, PR; pulse rate, RR; respiratory rate, BT; body temperature, APACHE; Acute Physiology and Chronic Health Evaluation

Table 3

Comparison between Preoperative Radiologic Findings and Postoperative Findings

Abbreviations: CT; computed tomography, MRI; magnetic resonance imaging, AAST; American Association for the Surgery of Trauma

^*Additional examination (ERCP)

Table 4

Patients Characteristics and Clinical Course

Abbreviations: SPDP; spleen preserving distal pancreatectomy, PPPD; pylorus preserving pancreaticoduodenectomy, DP; distal pancreatectomy, STP; subtotal pancreatectomy

^*Combiled operation: S2 segmentectomy, ^†Combined operation: right hemicolectomy

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Surgical Treatment of Pancreatic Trauma in Children

J Korean Assoc Pediatr Surg. 2013;19(2):98-107. Published online December 24, 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.98

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Surgical Treatment of Pancreatic Trauma in Children

J Korean Assoc Pediatr Surg. 2013;19(2):98-107. Published online December 24, 2013

DOI: https://doi.org/10.13029/jkaps.2013.19.2.98

Surgical Treatment of Pancreatic Trauma in Children

Table 1

AAST (American Association for the Surgery of Trauma) Classification

Table 2

Preoperative Clinical Findings and APACHE Score

Table 3

Comparison between Preoperative Radiologic Findings and Postoperative Findings

Abbreviations: CT; computed tomography, MRI; magnetic resonance imaging, AAST; American Association for the Surgery of Trauma

^*Additional examination (ERCP)

Table 4

Patients Characteristics and Clinical Course

Abbreviations: SPDP; spleen preserving distal pancreatectomy, PPPD; pylorus preserving pancreaticoduodenectomy, DP; distal pancreatectomy, STP; subtotal pancreatectomy

^*Combiled operation: S2 segmentectomy, ^†Combined operation: right hemicolectomy

Table 1 AAST (American Association for the Surgery of Trauma) Classification

Table 2 Preoperative Clinical Findings and APACHE Score

Table 3 Comparison between Preoperative Radiologic Findings and Postoperative Findings

Abbreviations: CT; computed tomography, MRI; magnetic resonance imaging, AAST; American Association for the Surgery of Trauma

^*Additional examination (ERCP)

Table 4 Patients Characteristics and Clinical Course

Abbreviations: SPDP; spleen preserving distal pancreatectomy, PPPD; pylorus preserving pancreaticoduodenectomy, DP; distal pancreatectomy, STP; subtotal pancreatectomy

^*Combiled operation: S2 segmentectomy, ^†Combined operation: right hemicolectomy

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