Pediatric Pancreatic Trauma: Single Institution Experience
[1]
Ibrahim Salih Elkheir, Department of Surgery, Faculty of Medicine, Alzaeim Alazhari University, Khartoum, Sudan.
[2]
Saadeldin Ahmed Idris, Department of Surgery, Faculty of Medicine, Alzaeim Alazhari University, Khartoum, Sudan.
[3]
Amir Abdalla Mohamadin, Department of Surgery, Faculty of Medicine, Alneelain University, Khartoum, Sudan.
Pancreatic pseudocyst is a rare pathology of the pancreas. It is mostly post traumatic in pediatrics set. To present our experience with the treatment of pancreatitis and pancreatic pseudocysts in children up to the age of twelve years caused by blunt abdominal trauma, a cross sectional study was conducted after receiving research ethics approval. The study included all consecutive pediatric patients who sustained pancreatic trauma (Khartoum North Teaching Hospital, Sudan, from October 2010 to September 2015). Data were analyzed by SPSS version 21.0. Seven patients had pancreatic injury due to blunt abdominal trauma (Acute pancreatitis in 1, and pancreatic pseudocyst 6 patients). Their mean age was 6.43 years (Range, 4─ 11 years). The mean interval between onset of trauma and presentation was 14.1 weeks. Presentation was variable; vomiting, abdominal pain, and fever in 57.1%, 57.1%, and 28.6% respectively. Serum amylase elevated in 14.3%. Sensitivity of abdominal US and CT scan was 43.9% and 100% respectively. Patient with acute pancreatitis responded well to conservative measures. One pancreatic pseudocyst had ruptured while awaiting surgery and managed by emergency external drainage; later on it recurred and necessitates formal elective surgery. Elective surgical drainage was cystogastrostomy. Neither complications nor relapse were documented during their follow- up. There was no mortality in the current study. In conclusion; Post traumatic pancreatic pseudocyst in children is a rare but nevertheless significant clinical entity, it should be suspected in patients that develop vomiting, abdominal fullness and pain few days following blunt abdominal trauma.
Pediatrics, Abdominal Trauma, Pancreatic, Pseudocyst, Surgical Intervention
[1]
Giakoustidis A., Antoniadis N., Giorgakis I., Tsoulfas G., Dimitriadis E., Giakoustidis D. Pancreatic pseudocyst in a child due to blunt andominal trauma during a football game. Hippokratia., 2012; 16 (1): 71-73.
[2]
Cannon J. W., Callery M. P., Vollmer Jr. C. M. “Diagnosis and management of pancreatic pseudocysts: what is the evidence?” Journal of the American College of Surgeons, 2009; 209(3): 385–393.
[3]
Zerem E., Hauser G., Loga-Zec S., Kunosić S., Jovanović P., Crnkić D. Minimally invasive treatment of pancreatic pseudocysts. World Journal of Gastroenterology (WJG), 2015; 21(22): 6850-6860.
[4]
Ajani R. S. Post-traumatic Pancreatic Pseudocyst in a Nigerian boy – Case Report and Review of Literature. African Journal of Biomedical Research, 2009; 12(1): 77-82.
[5]
Brun A., Agarwal N., Pitchumomi C. S. Fluid collections in and around the pancreas in acute pancreatits. J ClinGastroenterol., Aug 2011; 45(7): 614-25.
[6]
Apostolou C., Krige J. E. J., Bornman P. C. A review: Pancreatic pseudocysts. SAJS, 2006; 44(4): 148-155.
[7]
Beckingham I. J., Krige J. E. J., Bornman P. C., Terblanche J. Long term outcome of endoscopic drainage of pancreatic pseudocysts. Am J Gastroenterol., 1999; 94: 71-74.
[8]
Marjanovic V. G., Slavkovic A. R., Stojanovic M. P., Stefanovic V. B., Marjanovic G. T., Jankovic R. J. Somatostatine analogue in nonoperative treatment of posttraumatic pancreatic pseudocyst in a child: a case report. Cent. Eur. J. Med., 2012; 7(1): 34-37.
[9]
Habashi S., Draganov P. V. Pancreatic pseudocyst. World J Gastroenterol., 2009; 15(1): 38-47.
[10]
Al-Ahmadi K., Ahmed N. Outcomes after pancreatic trauma: experience at a single institution. J can chir., 2008; 51(2): 118-124.
[11]
Khanna A. K., Tiwary S. K., Kumar P. “Pancreatic Pseudocyst: Therapeutic Dilemma,” International Journal of Inflammation, vol. 2012, Article ID 279476, 7 pages, 2012.
[12]
Maule W. F., Reber H. A. Diagnosis and Management of Pancreatic Pseudocysts, Pancreatic Ascites, and Pancreatic Fistulas. The Pancreas: Biology, Pathobiology and Disease. 2nd Edition. 1993; 741-50.
[13]
Pitchumoni C. S., Agarwal N. Pancreatic pseudocysts. When and how should drainage be performed? (Review). Gastroenterology Clinics of North America, 1999; 28 (3): 615-639.
[14]
Lerch M., Stier A., Wahnschaffe U., Mayerle J. Pancreatic pseudocysts. DtschArztebl Int., 2009; 106(38): 614-21.
[15]
Heider R., Meyer A. A., Galanko J. A., Behrns K. E. Percutaneous drainage of pancreatic pseudocysts is associated with a higher failure rate than surgical treatment in unselected patients. Ann Surg., 1999; 6: 781–789.
[16]
Vitale G. C., Lawhon J. C., Larson G. M., Harrell D. J., Reed D. N. Jr., Mac Leod S. Endoscopic drainage of the pancreatic pseudocyst. Surgery, 1999; 126: 616–21.
[17]
Baillie J. Pancreatic pseudocysts (part I). Gastrointestinal endoscopy, 2004; 59(7): 873-9.
[18]
Jedlica R. Eineneun Operationsmethode der Pancreacysten (Pancreatogastrostomie) ZentralblChir., 1923; 50: 132.
[19]
Han O. BeitragzurBehandlung der Pankreasfistein. Arch KlinChir., 1928; 143: 73.
[20]
Jurasz A. ZurFragë der ZuroperativenBehandlung der Pancreacysten. Arch fürKlinischeChirurgie, 1931; 164:272-279.
[21]
Alladi A, Venkatachalapathy TS (2012) Pancreatic Injury in Children: Role of Nonoperative Management. Pancreat Disorders Ther., 2012; 2(4):108.
[22]
Fennema E. M., Nellensteijn D. R., Nieuwenhuijs V. B., van Rheenen P. F., ten Duis H. J., Hulscher J. B. F. Pancreatic injury in abdominal trauma in children: difficult to diagnose and treat. Ned TijdschrGeneeskd., 2011; 155 (A2406): 99-107.
[23]
Marjanović Z., Slavković A., Đorđević I., Đerić D. Modern treatment of blunt pancreatic injuries in children. ActaMedicaMedianae, 2015; 54(2):48-51.
[24]
Patel S. V., Spencer J. A., el-Hasani S., Sheridan M. B. Imaging of pancreatic trauma. Br J Radiol., 1998;71:985-990.
[25]
Kang H. J., Choi S. B., Choi S. Y. Surgical experience and clinical outcome of traumatic pancreatic injury. Korean J Hepatobiliary Pancreat Surg., 2012;16:160-166.
[26]
Boggs B. R., Potts J. R., Postier R. G. Five year experience with pancreatic pseudocysts. Am J Surgery, 1982; 144:685-688.
[27]
De Angelis P, Romeo E, Rea F, Torroni F, Caldaro T, et al. Miniprobe EUS in management of pancreatic pseudocyst. World J Gastrointest Endosc., 2013; 5(5): 255-260.
