A Case of Pediatric Type IIIb Pancreatic Trauma With the Major Pancreatic Ductal Injury Treated by Non-Operative Management Including ERP

Abstract

A 13-year-old girl fell while running and bruised her abdomen on the asphalt ground. She visited a nearby clinic on the same day and was followed up, but fever, abdominal pain, and vomiting persisted. Contrast-enhanced CT revealed the rupture of the pancreatic head/body, so she was referred to our hospital 15 days after the injury. She underwent endoscopic retrograde pancreatography (ERP), and since imaging from the main pancreatic duct did not enhance the distal pancreatic duct, we diagnosed her as having type IIIb traumatic pancreatic injury. We attempted to place an endoscopic nasopancreatic drainage (ENPD) tube on the distal side, but it reached only up to the rupture site. Fasting was introduced and antibiotics, gabexate mesylate, and octreotide acetate were administered, but percutaneous drainage was added because of decreased drainage from ENPD and increased ascites. After that, her ascites tended to decrease, her blood amylase level improved, and she was discharged from the hospital on the 86th day after her injury. Surgery is usually considered necessary for type IIIb traumatic pancreatic injury, but non-operative management is possible if a long time has passed since the onset.