2020 Volume 56 Issue 6 Pages 932-938
Purpose: The optimal management for pancreatic injuries in children involving a laceration of the main pancreatic duct remains to be established. We generally treat children with pancreatic injury by non-operative management whenever possible. We herein evaluate our management protocol.
Methods: Eighteen children were treated at our institution from January 2000 to December 2019.
Results: The median age was 7.1 years (range, 0.9～14.5 years). The pancreatic injuries in these children classified in accordance with the Japanese criteria comprised type I in nine, type II in two, type IIIa in two, and type IIIb in five. All five patients with pseudocysts underwent either open or percutaneous drainage. Type I/II patients included one with hemorrhagic ascites, who underwent open pseudocyst drainage, and one with deep hepatic injury, who underwent open hemostasis and drainage. Two type IIIb patients included one with deep hepatic injury, who underwent open hemostasis and drainage, and one who demonstrated compensated shock with massive ascites and underwent distal pancreatectomy and drainage as the initial treatments. In the other two type IIIb patients, one with leaking pancreatic juice underwent the Letton-Wilson procedure, and one with a residual pancreatic pseudocyst underwent cystogastrostomy during the treatment course. Endoscopic retrograde pancreatography was performed in three patients, but all of them were carried out more than one week after the injury, and pancreatic duct stenting beyond the injured area was difficult.
Conclusions: Operative management was required in almost all type IIIb patients, and early surgical intervention should be considered in type IIIb cases.
