2022 Volume 58 Issue 6 Pages 919-926
We herein report the case of a six-year-old girl who was successfully treated by central pancreatectomy for grade IIIb traumatic pancreas injury. She was transferred to our hospital because of a cystic lesion in the pancreas with abdominal pain persisting for one week. Traumatic pancreatic injury with a pseudopancreatic cyst was suspected, and nonoperative management was selected. Twenty days after admission, a pseudoaneurysm of the left gastric artery ruptured, and emergency embolization was performed using interventional radiology. On the 31st hospitalization day, endoscopic retrograde pancreatography (ERP) revealed the main pancreatic duct injury. We performed surgical treatment for pancreatic injury grade IIIb on the 78th hospitalization day. The pancreas was partially transected at the pancreas head, and the main pancreatic duct was completely transected. The pancreas was completely dissected, the proximal pancreatic stump was closed, and the distal pancreas was anastomosed directly in the posterior stomach wall. She did not require any treatment after the operation. The decision to proceed with surgery was difficult because nonoperative management sometimes results in a better outcome than an operative approach, but the early diagnosis of injury of the main pancreatic duct led to the decision to proceed with surgery. ERP is a feasible option for diagnosing high-grade traumatic pancreas injury, even in pediatric patients.
