Pancreatic blunt trauma in children: observations froma a monocentric pilot study
(2019) 31st Edition of the Belgian Week of Gastroenterology — Location: Anvers, Belgique (20.February.2019)
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- Introduction Pancreatic trauma is the fourth most frequent cause of abdominal trauma in children. Few studies focused on the impact of trauma severity and therapeutic management (surgery vs endoscopy vs observation) on mid- and long-term outcomes. Aim The aim of this study was to determine the mid and long-term morbidities related to the grade and the initial management of pancreatic trauma in children. Methods The charts of 29 children aged 0-<18 years admitted at The Cliniques Universitaires St Luc between 01/2007 and 01/2017 for an abdominal trauma involving the pancreas were retrospectively reviewed. Data about trauma characteristics, clinical symptoms, imaging, therapeutic management and short to long-term complications were recorded. Results We identified 29 patients (18/29, 62% boys) aged 2-17 years (median: 6.9y). Most children (18/29, 62%) had a mild pancreatic trauma (AAST grade I-II), while 11 had more severe (grade III-IV) pancreatic lesions. In 22/29 (76%) patients, pancreas trauma was associated to another organ lesion, liver injury being the most prevalent (17/22, 77%). Clinical symptoms are nonspecific to diagnose pancreatic involvement: pain (27/29, 93%) and nausea/vomiting (15/29, 52%). Imaging by CT-scan suspected ductal involvement in 90% of grade III-IV traumas. Five children were managed by endoscopy (3/5 grade III, 2/4 grade IV), 3 (3/3 grade IV injuries) patients had surgical management (2 by pancreatico-jejunostomy and 1 for percutaneous drainage), while the other children were managed conservatively. Hospital stay was significantly shorter in grade I compared to the more severe grades (13 vs 19.5 days, p = 0.025). Mediate complications of pancreatic trauma consisted of pseudocysts; these were exclusively seen in grade III (5/5, 100%) and IV (4/5, 80%) traumas. Endocrine and exocrine pancreatic function was followed (median follow-up: 20.3 months) in 9/11 and 7/11 patients respectively with grade III-IV traumas. Endocrine function was preserved in all of them. Instead, exocrine function was impaired in 3/7 (43%); all of them complained of intermittent symptoms of abdominal pain and steatorrhea. Conclusions This monocentric study showed that compared to grade I-II pancreatic traumas, children admitted for pancreatic blunt injury grade III-IV had a higher risk of pseudocysts, required longer hospitalisation and more frequent re-hospitalisation for pancreatic reasons, and were more likely to evolve to exocrine pancreatic dysfunction over time. Follow-up of patients with grade III-IV-V pancreatic trauma is thus important to detect mid and long-term complications. Extending this study to a multicentric study will better enable us to analyse the effect of operative vs endoscopy vs observation management on the long-term outcome of these patients.
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Sonnino, G., Deprez, P., Pire, A., Zech, F., Reding, R., Smets, F., Stephenne, X., Sokal, E., & Scheers, I. (2019). Pancreatic blunt trauma in children: observations froma a monocentric pilot study. 31st Edition of the Belgian Week of Gastroenterology, Anvers, Belgique.