Two Surgically Treated Cases of Traumatic Type IIIb Pancreatic Injury in Children

Abstract

The treatment algorithm for traumatic type IIIb pancreatic injury in children is still undetermined. We report two cases of traumatic pancreatic injury in children treated at our hospital. Case 1: A three-year-old girl was initially diagnosed as having type IIIa pancreatic injury on the basis of enhanced CT findings. However, the second enhanced CT performed 13 days after the accident led to a final diagnosis of type IIIb pancreatic injury. Although ascite and peripancreatic cyst drainage was performed, her condition did not improve. A spleen-preserving distal pancreatectomy was performed 83 days after the accident, and her postoperative course was uneventful. Case 2: A nine-year-old boy was diagnosed as having type IIIb pancreatic injury on the basis of enhanced CT findings. As his general condition was good with tolerance for definitive surgery, he underwent a spleen-preserving distal pancreatectomy on the day of his injury. Although he developed a postoperative pancreatic fistula, he recovered with conservative treatment. Initial pancreatectomy may be an alternative for pediatric patients with type IIIb pancreatic injury when drainage of the pancreatic fluid is difficult and their general condition permits surgery.