Early Diagnosis of a Pediatric Pancreatic Tumor by Abdominal Physical Examination: A Case Report |
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| Affiliation: | 1. Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo, Japan;2. Department of Emergency and Disaster Medicine, Hirosaki University, Aomori, Japan;3. Department of Surgery, Tokyo Metropolitan Children''s Medical Center, Tokyo, Japan;1. Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH;2. Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;3. Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH;1. Office for Health Equity and Inclusion, University of Michigan, Ann Arbor, Michigan;2. University of Michigan Medical School, Ann Arbor, Michigan;3. Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan;4. Department of Pediatric Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan;1. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California;2. Department of Emergency Medicine, UC San Diego Health System, San Diego, California;1. Head of Pediatric Orthopedics Department No. 11, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Russia;2. Pediatric orthopedic surgeon and Post-doctoral Fellow and the Department of Pediatric Orthopedics No. 11, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, 6 M.Ulyanova Street, Kurgan, 640014, Russia;3. Orthopedic surgeon, Pediatric Orthopedics Department No. 11, Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics, Russia;1. Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA;2. Department of Pediatrics: Center for Pediatric and Adolescent Comparative Effectiveness Research Indianapolis, IN, USA;3. Department of Medicine, Indiana University School of Medicine, Indiana and Cleveland Clinic Learner Institute, Indianapolis, Cleveland, OH, USA;4. Children''s Health Services Research Center, Indiana University School of Medicine, Indianapolis, IN, USA;5. Research Jam (Patient Engagement Core), Indiana Clinical and Translational Sciences Institute, Indiana University School of Medicine Indianapolis, IN, USA |
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| Abstract: | ![]()
BackgroundDetecting a neoplasm in pediatric patients with acute abdominal pain is difficult, especially when there is no palpable mass. Ihara's maneuver, which allows the physician to apply manual pressure directly on the pancreatic body, is a useful palpation method of diagnosing acute pancreatitis in children. We report a case of solid pseudopapillary neoplasm of the pancreas (SPNP) detected by Ihara's maneuver.Case ReportAn otherwise healthy, 15-year-old male visited our emergency department with acute abdominal pain and nausea. His vital signs were appropriate for his age. A physical examination denied peritoneal signs, but Ihara's maneuver induced strong tenderness. His serum amylase and lipase were normal. A contrast-enhanced computed tomography scan revealed a well-defined, 2.2-cm, nonenhanced mass in the pancreatic tail. Laparoscopic distal pancreatectomy was performed, and the diagnosis of SPNP was confirmed. The patient was well postoperatively without any metastasis. SPNP is a rare neoplasm with low malignant potential. Although it typically occurs in young females, it has also been reported in children. The early diagnosis of SPNP is usually challenging because most patients do not have specific symptoms or laboratory findings. In the present case, the SPNP was difficult to detect by palpation because of its size, but Ihara's maneuver induced strong tenderness of the pancreas and led to a diagnosis.Why Should an Emergency Physician Be Aware of This?Ihara's maneuver has the potential to enable early diagnosis not only of pancreatitis but also of pancreatic tumors, such as SPNP. |
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| Keywords: | children Ihara's maneuver pancreatic tumor physical examination solid pseudopapillary neoplasm of the pancreas |
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