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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Pancreatic trauma in children.J Pediatr Surg. 2004; 39: 96-99
- Conservative management of pancreatic trauma in children.J of Trauma. 1997; 42: 1097-1100
- Pediatric pancreatic trauma: predictors of nonoperative management failure and associated outcomes.J Pediatr Surg. 2007; 42 (Epub 2007/02/03): 340-344
- Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center.J Pediatr Surg. 2015; 50 (Epub 2015/02/02): 335-338
- Management of pancreatic injury in pediatric blunt abdominal trauma.J Pediatr Surg. 1999; 34 (discussion 23-4. Epub 1999/06/08): 818-823
- Non-operative versus operative treatment for blunt pancreatic trauma in children.Cochrane Database Syst Rev. 2014; (CD009746. Epub 2014/02/14)
- Organ injury scaling, II: pancreas, duodenum, small bowel, colon, and rectum.J Trauma. 1990; 30 (Epub 1990/11/01): 1427-1429
- Management of adult pancreatic injuries: a practice management guideline from the eastern association for the surgery of trauma.J Trauma Acute Care Surg. 2017; 82 (Epub 2016/10/28): 185-199
- Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes.J Am Coll Surg. 2014; 218 (Epub 2014/01/21): 157-162
- Surgical management of major pancreatic injury in children.Eur j of pediatr surg. 2007; 17 (Epub 2007/10/31): 317-321
- Early operation in children with pancreas transection.J Pediatr Surg. 2001; 36: 341-344
- Pancreatic trauma in children.Br J Surg. 2005; 92 (Epub 2005/01/27): 467-470
- Conservative management of blunt pancreatic trauma in children: a single center experience.Eur J of Pediatr Surg. 2013; 23: 470-473
- Pancreatic injury in children: good outcome of nonoperative treatment.J Pediatr Surg. 2008; 43: 1640-1643
- How should meta-regression analyses be undertaken and interpreted?.Stat Med. 2002; 21 (Epub 2002/07/12): 1559-1573
- Measuring inconsistency in meta-analyses.Bmj. 2003; 327 (Epub 2003/09/06): 557-560
- Pancreatic injury due to blunt abdominal trauma in children.Med Sci (Turkey). 2019; 8: 225-228
- [Management of blunt duodenal and pancreatic injuries in children (about a series of 8 cases)].Tunis Med. 2010; 88 (Epub 2010/08/17. Prise en charge des traumatismes fermes du bloc duodeno- pancreatique chez l'enfant (a propos d'une serie de 8 cas)): 586-592
- Non-operative management of high-grade pancreatic trauma: is it worth the wait?.J Pediatr Surg. 2013; 48 (Epub 2013/05/25): 1060-1064
- Management of major pancreatic duct injuries in children.J Trauma Inj Infect Crit Care. 2001; 50: 1001-1007
- Nonoperative management of pancreatic injuries in pediatric patients.Surg Today. 2011; 41 (Epub 2011/05/03): 655-659
- Islam S. pediatric pancreatic trauma: trending toward nonoperative management?.Am Surg. 2012; 78: 1204-1210
- Selective management of pediatric pancreatic injuries.J Pediatr Surg. 1999; 34 (Epub 1999/08/12): 1142-1147
- Blunt trauma pancreas in children: is non-operative management appropriate for all grades?.Pediatr Gastroenterol Hepatol Nutr. 2017; 20: 252-258
- Management of pancreatic injuries with blunt abdominal trauma in children.Case Ser. J Trauma Treat. 2013; : 2
- Traumatic pancreatitis: long-term review of initial non-operative management in children.J Paediatr Child Health. 1999; 35 (Epub 1999/05/11): 78-81
- Management of blunt pancreatic trauma in children.Surg. Today. 2009; 39: 115-119
- What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children?.Scand J Gastroenterol. 2016; 51 (Epub 2015/07/23): 218-224
- Blunt pancreatic trauma in children.Surg Today. 2011; 41 (Epub 2011/07/13): 946-954
- Nonoperative management of blunt pancreatic injury in childhood.J Pediatr Surg. 1999; 34 (Epub 1999/12/11): 1736-1739
- Blunt pancreatic injuries in children.Ann Chir. 2001; 126: 992-995
- Operative vs nonoperative management of pediatric blunt pancreatic trauma: evaluation of the national trauma data bank.J Am Coll Surg. 2016; 222: 977-982
- The management of pancreatic injuries in children: operate or observe.J Pediatr Surg. 2011; 46 (Epub 2011/06/21): 1140-1143
- Pancreatic injury from blunt abdominal trauma in childhood.Acta Chir Belg. 2005; 105 (Epub 2005/07/16): 283-286
- Management of blunt pancreatic injuries in children.Eur J Trauma. 2003; 29: 151-155
- Nonoperative management of pancreatic injuries in children.J Pediatr Surg. 1998; 33 (Epub 1998/03/14): 343-349
- Characteristics of pancreatic injury in children: a comparison with such injury in adults.J Pediatr Surg. 1996; 31 (Epub 1996/07/01): 896-900
- Initial resection of potentially viable tissue is not optimal treatment for grades ii-iv pancreatic injuries.World J Surg. 2009; 33 (Epub 2008/04/12): 221-227
- Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children.J Pediatr Surg. 2001; 36: 823-827
- Operative vs nonoperative management of blunt pancreatic trauma in children.J Pediatr Surg. 2010; 45 (Epub 2010/02/16): 401-406
- Pancreatic injury in children: review of 7 cases and the pertinent literature.Hepatogastroenterology. 2012; 59 (Epub 2011/09/24): 574-577
- Pancreatic trauma in children: mechanisms of injury.J of Trauma. 1997; 42: 49-53
- Pancreatic injuries in children.S Afr j of sur Suid-Afrik tydskr vir chirur. 1991; 29 (Epub 1991/06/01): 39-40
- Operative intervention for complete pancreatic transection in children sustaining blunt abdominal trauma: revisiting an organ salvage technique.Am Surg. 2011; 77: 612-620
- Management of severe blunt pancreatic trauma in children.Personal exp La Pediatria medi e chirur. 2001; 23 (Epub 2001/11/29): 179-182
- Pancreatic trauma in scottish children.J R Coll Surg Edinb. 2000; 45 (Epub 2000/12/29): 223-226
- Abdominal injuries involving bicycle handlebars in 219 children: results of 8-year follow-up.Eur J of Trauma & Emerg Surg. 2015; 41: 551-555
- Surgical outcomes of pancreaticoduodenal injuries in children.Pediatr Surg Int. 2018; 34: 641-645
- Management of blunt pancreatic trauma in children: review of the national trauma data bank.J. Pediatr. Surg. 2016; 51 (Epub 2016/09/01): 1526-1531
- Pancreatic trauma: a ten-year multi-institutional experience.Am Surg. 1997; 63: 598-604
- Operative versus nonoperative management of blunt pancreatic trauma in children: a systematic review.Pancreas. 2017; 46 (Epub 2017/09/14): 1091-1097
- The role of endoscopic retrograde pancreatography in pancreatic trauma: a critical appraisal of 48 patients treated at a tertiary institution.J Trauma Acute Care Surg. 2014; 76 (Epub 2014/05/24): 1362-1366
- A comparative evaluation of outcomes of endoscopic versus percutaneous drainage for symptomatic pancreatic pseudocysts.Gastrointest Endosc. 2014; 79 (quiz 83 e2, 83 e5. Epub 2013/12/10): 921-928
- Lumen-apposing metal stents for pancreatic fluid collection drainage: a review of current outcomes.BioMedicine and Surgery. 2017; 1: 88-93
- Management of blunt pancreatic injury in children.Journal of Trauma. 1999; 47: 1098-1103
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.