A Case of Blunt Pancreatic Trauma With Main Pancreatic Duct Injury in a Child

Abstract

Pancreatic trauma with main pancreatic duct injury is rare in children, and its standard therapy has not been established. We report the case of a pediatric patient with main pancreatic duct injury. A 6-year-old boy was transferred to our hospital with abdominal pain after blunt abdominal trauma. Computed tomography demonstrated complete transection of the pancreas, which we diagnosed as type IIIb pancreatic injury according to the criteria of the Japanese Association for the Surgery of Trauma. Use of endoscopic pancreatic stents was difficult because of stricture of the main pancreatic duct. His general condition was unstable and peritoneal irritation was apparent. We, therefore, decided on surgical treatment, and abdominal drainage was performed. On postoperative day 5, his symptoms of peritoneal irritation worsened, and amylase levels in drainage fluid were high. Distal pancreatectomy with splenectomy was subsequently performed because of the severe adhesion of organs in the abdominal cavity. Postoperatively, he needed a second operation, because of leakage of pancreatic juice and splenic vein bleeding. The patient was discharged on hospital day 43. He is doing well, and pancreatic function has remained well-preserved for 6 months postoperatively. There have been several reports that type IIIb pancreatic injury was successfully treated by nonoperative management. When the initial nonoperative management was not effective for children with type IIIb pancreatic injury, in those undergoing pancreatic resection, the operative procedure must be carefully selected, taking into consideration the secondary drainage.