2020 Volume 56 Issue 2 Pages 200-204
A 9-year-old boy was brought to our hospital because of epigastric pain caused by blunt abdominal trauma. Computed tomography showed a small amount of fluid accumulation around the pancreas, and a conservative treatment with antibiotics and a protease inhibitor was initiated owing to suspicion of pancreatic injury. On the second day of hospitalization, contrast computed tomography revealed a low-density discontinuity in the pancreatic body, and he was diagnosed as having traumatic pancreatic injury; however, we were unable to determine the presence or absence of the main pancreatic duct injury. On the third day, endoscopic retrograde pancreatography confirmed the disruption of the main pancreatic duct in the pancreatic body, with extravasation of contrast medium. He was diagnosed as having type IIIb pancreatic injury according to the criteria of the Japanese Association for the Surgery of Trauma, and emergency laparotomy was performed. At the site of pancreatic laceration, distal pancreatectomy with splenectomy was performed. The postoperative course was uneventful, and he was discharged 11 days after injury. Even in children, when there is a suspicion of main pancreatic duct injury, endoscopic retrograde pancreatography should be performed immediately. In addition, when the main pancreatic duct disruption is confirmed in the early stage of injury, surgical treatment should also be considered in children.
