Management Of Blunt Duodenal And Pancreatic Injuries In Children (About A Series Of 8 Cases)

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Published Aug 5, 2010
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Vol. 88 No. 8 (2010): Issue Aug 2010

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Lilia Ben Hassine
Nizar Boughanmi
Wiem Douira
Jihène Mormèche
Héla Louati
Mourad Hamzaoui
Béji Chaouachi
Ibtissem Bellagha

Abstract

Aim : The aim of this retrospective study is to report eight cases of blunt duodeno-pancreatic trauma in infants, emphasizing on the role of imaging in acute assessment of the lesions and in further management.
Methods : We reported eight cases of duodeno-pancreatic injuries between 2006 and 2008, 5 boys and 3 girls with an age ranging from 3 to 12 years (median age : 7 years). Trauma circumstances were : car accident (n=2), domestic injury (n=5) and bicycle’s fall injury (n=1). All patients underwent abdominal ultrasonography and CT scan in the initial evaluation and during the follow-up.
Results : Imaging showed the following pancreatic lesions : 3 corporeal fractures, 2 caudal fractures and one between the corporeal and the caudal portions. Four pancreatic haematomas were found.
The associated lesions were duodenal, splenic, hepatic and renal. Two isolated duodenal haematomas were found. Two patients improved spontaneously, the six others developed complications : 4 acute pancreatitis, two infections, 3 pseudocysts and one retroperitoneal collection. Management was chirurgical in one case, medical in two cases, endoscopic in 2 cases and three percutaneaous drainages were performed.
Conclusion : Blunt duodeno-pancreatic injuries in children have to be evaluated by an early imaging modality, in order to perform acute assessment of the lesions. Primary conservative treatment is advocated while clinic, biologic and imaging follow-up is required to detect complications, which management can be endoscopic,
percutaneous or surgical.

Keywords:

Pancreas, Trauma, Child, Diagnosis, Management, TDM, Endoscopy

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References

  1. Sukul K, Lont HE, Johannes EJ. Management of pancreatic injuries. Hepatogastroenterology 1992;39:447-50.
  2. Wales PW, Shuckett B, Kim PC. Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children. J Pediatric Surg 2001;36:823-7.
  3. Bleichner JP, Guillon YM, Martin L, Seguin P, Mallédant Y. Pancréatite après traumatisme fermé de l'abdomen. Ann Fr Anesth Réanim 1998;17:250-3.
  4. Farrel RJ, Krige JE, Bornman PC, Knottenbelt JD, Terblanche J. Operative strategies in pancreatic trauma. Br J Surg 1996;83: 867- 934.
  5. Jurkzak F, Kahn X, Letessier E, Plattner V, Heloury Y, LeNeel JC. Traumatismes fermés duodéno-pancréatiques sévères A propos d'une série de 30 patients. Ann Chir 1999;53:267-72.
  6. Devoitille A, Dominé F, De Roover A et al. Mise au point et traitement des traumatismes pancréatiques chez l'enfant. Rev Med Liège 2002;57:760-764.
  7. Khatouf M, Ababou A, Mosadiq A et al. Acute post-traumatic pancreatitis JEUR 2001 ;14 :199-202.
  8. Dubois J, Porcheron J, Lacroix M, Menaoui N. Traumatisme du pancréas à huit clos. Gastro Médical Staff 1998;46:6-8.
  9. Cogbil TH, Moore EE, Morrig JA, Hoyt DB. Distal pancreatectomy for trauma: A multicenter experience. J Trauma 1991;31:1600-6.
  10. Arkovitz MS, Johnson N, Garcia VF. Pancreatic trauma in children: mechanisms of injury. J Trauma 1997;42:49-53.
  11. Taskishima T, Sugimoto K, Hirata M, Asari Y, Ohwada T, Kakita A. Serum amylase level on admission in the diagnosis of blunt injury to the pancreas. Ann Surg 1997;226:70-6.
  12. Sjovall A, Hirsch K. Blunt abdominal trauma in children : risks of nonoperative treatment. J Pediatr Surg 1997;32:1169-74.
  13. Thanh LN, Duchmann JC, Latrive JP, That BT, Huguier M. Conservation of the left pancreas in rupture of the pancreatic isthmus. Chirurgie 1999;124:165-70.
  14. Jobst MA, Canty TG Sr, Lynch FP. Management of pancreatic injury in paediatric blunt abdominal trauma. J Pediatr Surg 1999;34:818-23.
  15. Bradley EL, Young PR, Chang MC et al. Diagnosis and initial management of blunt pancreatic trauma:guidelines from a multiinstitutional review. Ann Surg 1998;227:861-9.
  16. Richardson MC, Hollman AS, Davis CF. Comparaison of CT and US imaging in the assessment of blunt abdominal trauma in children. Br J Surg 1997; 84:1144-6.
  17. Peitzman AB, Makaroun MS, Slasky BS, Ritter P. Prospective study of computed tomography in initial management of blunt. J Trauma 1986;26:585-92.
  18. Chambon JP, Quandalle P, Lemaitre L, Wortz A, Sabecki L, Saudemont A. La tomodensitométrie de l'abdomen dans huit cas de traumatisme. Ann Chir 1990;44: 575-80.
  19. Lucas CE. Diagnosis and treatment of pancreatic and duodenal injury. Surg Clin North Am 1977;57: 49-65.
  20. Moore EE, Cogbill TH, Malangoni MA et al. Organ injury scaling 2: pancreas, duodenum, small bowel, colon, rectum. J Trauma 1990;30:1427-9.
  21. Kouchi K, Tanabe M, Yoshida H et al. Nonoperative management of blunt pancreatic injury in childhood. J Pediatr Surg 1999;34:1736-9.
  22. Canty TG Sr, Weinman D. Treatment of pancreatic duct disruption in children by an endoscopically placed stent. J Pediatr Surg 2001;36:345-8.
  23. Kurzenne JY, Brucher P, Vergnes P et al. Blunt injuries of the pancreas in children. Diagnostic and therapeutic approach apropos of 8 cases. Chir Pediatr 1987;28:32-8.