High-grade pancreatic trauma in pediatric patients: two cases of successful non-operative management

CASE REPORT: We report two cases of pediatric pancreatic trauma. Both involved ductal injury demonstrated on imaging. Both patients qualify as grade III injuries according to the OIS as developed by the American Association for the Surgery of Trauma. Both patients were managed non-operatively using nasogastric suction, NPO, and total parenteral nutrition (TPN). Both patients had complete resolution of their pancreatic injury without pseudocyst formation or need for any operative intervention.

CONCLUSION: The two cases presented illustrate severe pediatric pancreatic trauma resolving after a non-operative course. A lack of consensus exists on whether severe pancreatic trauma should be addressed operatively or non-operatively, owing to differences in hospital stay and cost to the patient, time to resolution, and need for TPN. The pediatric surgery community is equally divided between early operative intervention and non-operative management. Inexperience with pancreatic trauma diagnosis and work-up can lead to delayed treatment and poor clinical outcomes. These cases show successful early diagnosis with non-operative treatment and good long-term clinical results.

INTRODUCTION: Pancreatic injury secondary to blunt abdominal trauma is a rare finding compared to other solid organ injuries. Diagnosis is difficult because of vague clinical presentation, quality of screening radiography and laboratory testing, and experience of practitioners. Furthermore, a lack of consensus on treatment modalities based on the organ injury scale (OIS) can further confuse management of pediatric patients.