Management of pancreatic and duodenal injuries in pediatric patients |
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Authors: | M C Plancq J Villamizar J Ricard J P Canarelli |
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Institution: | (1) Department of Pediatric Surgery, University Hospital of Amiens, 80054 Amiens, France, FR |
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Abstract: | Diagnosis of duodenal and pancreatic injuries is frequently delayed, and optimal treatment is often controversial. Fourteen
children with duodenal and/or pancreatic injuries secondary to blunt trauma were treated between 1980 and 1997. The pancreas
was injured in all but 1 child. An associated duodenal injury was present in 4. The preoperative diagnosis was suspected in
only 6 patients based on clinical signs and ultrasonography. One patient was treated successfully conservatively; all the
others required surgical management. At operation, three procedures were used: peripancreatic drainage, suture of the gland
or duodenum with drainage, and primary distal pancreatic resection without splenectomy. A duodenal resection with reconstruction
by duodeno-duodenostomy was performed in 1 case. The overall complication rate was 14%: 1 fistula and 1 pseudocyst. Pancreatic
ductal transection was recognized 3 days after the initial laparotomy by endoscopic retrograde cholangiopancreatography (ERCP).
The mortality was 7%; 1 patient died from septic and neurologic complications. When the diagnosis of pancreatic ductal injuries
is a major problem, ERCP may be a useful diagnostic procedure. Pancreatic injuries without a transected duct may often be
treated conservatively. The surgical or conservative management of duodenal hematomas is still controversial; other duodenal
injuries often need surgical treatment.
Accepted: 26 April 1999 |
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Keywords: | Pancreatic trauma Duodenal trauma Children |
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