Pancreatic injuries in children – Lessons learned from the last decade in a major northern European trauma center

Abstract text (incl. references and figure legends)

Introduction

Pediatric pancreatic injury is rare and associated with high risk of complications. The treatment of blunt pancreatic injuries in children remains controversial. We have standardized our protocol, addressing the ductal injuries with tail resection in Organ Injury Scale (OIS) grade 3 injuries and operative drainage in OIS grade 4 and 5 injuries, unless injury to the common bile duct (CBD). We present 10 years of experience.

Methods

Retrospective cohort study of all trauma patients under the age of 18 years admitted with pancreatic injury to our high volume trauma center and included in the Institutional Trauma Registry during the period 2010-2019.

Results

Twenty-five children with pancreatic injury were included with blunt mechanism of injury in 23/25 (92 %) and 10/25 (40 %) were handlebar injuries. Median ISS was 10 (IQR 10) and median LOS 13 days (IQR 3). A CT scan identified the injury in 20 cases (80 %), MRI in three and two patients were diagnosed during laparotomy. Two patients presented with combined pancreatic and duodenal injuries. Thirteen patients had OIS grade 1-2 injuries, 10 had OIS grade 3 and two had OIS grade 4 injuries. All patients with grade 3 injuries were treated with tail resection, 9 of them with splenic preservation. Three patients (30 %) developed a pancreatic fistula, all healed without intervention after 23, 24 and 25 days, respectively. Both OIS grade 4 patients were treated with surgically placed suction drainage and the fistulas healed after 21 and 27 days. The combined injuries had surgery for duodenal repair and drainage of their pancreas grade 2 injuries. No reoperations were required in the resection group and no pseudocysts were identified. ERCP was not necessary in any patients.

Conclusions

Standardized treatment of pancreatic injuries with spleen preserving tail resection of grade 3 and surgical drainage of grade 4 seems safe without any unforeseen complications or need for invasive procedures postoperatively.

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