Highlights
- •Blunt abdominal trauma is the major cause of abdominal injury in children.
- •No clear guidelines exist for the initial management of blunt pancreatic trauma in children.
- •Most patients with pancreatic trauma can initially be treated non-operatively, while early surgical treatment may benefit patients with lesions of the main pancreatic duct.
- •ERCP offers both highly accurate diagnosis and potential treatment of ductal injuries.
Abstract
AIM
Blunt abdominal trauma is the major cause of abdominal injury in children. No clear
guidelines exist for the initial management of blunt pancreatic trauma in children.
The aim of this study was to perform a systematic review and meta-analysis of initially
non-operative versus initially operative treatment in children with blunt pancreatic
injury.
METHODS
Studies including children (<18 years) with blunt pancreatic injuries published in
any language after year 1990 were included. Total of 849 studies were identified by
searching PubMed, Scopus, CINAHL and Cochrane Database. After review, 42 studies met
inclusion criteria and were included in this systematic review. There were 1754 patients,
of whom 1095 were initially managed non-operatively (NOM), and 659 operatively (OM).
Primary outcome was non-operative management success rate, and secondary outcomes
were mortality, complications (including specifically pseudocysts and pancreatic fistulas),
percent of patients and days on total parenteral nutrition (TPN), length of hospital
stay and readmissions.
RESULTS
There was no difference in mortality between NOM and OM groups. The incidence of pseudocysts
was significantly higher in NOM group compared to OM (P<0.001), especially for AAST grade III or higher (P<0.00001). Overall incidence of pancreatic fistulas was significantly lower for NOM
group (p = 0.02) but no difference was observed for AAST grades III or higher (p = 0.49). There was no difference in the length of hospital stay (P = 0.31). Duration of total parenteral nutrition was not different for all AAST grades
(P = 0.35), but was significantly shorter for OM group for AAST grades III and higher
(p = 0.0001). There was no overall difference in readmissions (P = 0.94). Overall success rate of initial non-operative treatment was 87%.
CONCLUSIONS
Most patients with pancreatic trauma can initially be treated non-operatively, while
early surgical treatment may benefit patients with lesions of the main pancreatic
duct. ERCP offers both highly accurate diagnosis and potential treatment of ductal
injuries.
Keywords
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Article info
Publication history
Published online: February 12, 2020
Accepted:
February 9,
2020
Footnotes
☆This paper is part of a supplement supported by The Croatian Trauma Society.
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
