Prospective Outcomes of Standardized Non-operative Management of Pancreatic Trauma With Ductal Injury in Children: Less is More.

Document Type

Article

Publication Date

1-2025

Identifier

DOI: 10.1016/j.jpedsurg.2024.161976

Abstract

BACKGROUND: Traumatic pancreatic laceration with ductal injury in children can be managed non-operatively (NOM); however, variable management affects outcomes. We hypothesized that a standardized management approach with early feeding and limited resource utilization is safe and improves outcomes.

METHOD: Prospective, multicenter study of 13 pediatric trauma centers (2018-2022). Children with blunt pancreatic trauma with ductal injury were managed per a standard NOM pathway. Outcomes were compared to a historical NOM cohort with variable management.

RESULTS: Of 22 patients, the median age was 7.5 years (range 1-14 years). Low-fat diet was started at median 4 days [IQR 2-7] and median hospital stay was 8 days [IQR 4-10]. One patient failed NOM and underwent distal pancreatectomy. Of the rest, most (17/21, 81%) had early recovery and discharged in median 6 days [IQR 4-8.25] while 4 (19%) had prolonged recovery (median stay 24 days, IQR 19.8-30.5) and higher peri-pancreatic cyst development (early 23.5% vs prolonged 75%,p = 0.05). Pancreatic ascites at presentation correlated with cyst development (p < 0.0001). Endoscopic stent (optional) was placed in 33% and did not prevent cyst development. Delayed exocrine pancreatic insufficiency was noted in 1 patient. Compared to the historic cohort (32 patients), TPN use was lower (pre-protocol 56% vs post 23%, p = 0.02), days to diet was shorter (pre-protocol 7 vs post 4; p = 0.03), and cyst development was lower (pre-protocol 81% vs post 33%, p < 0.001).

CONCLUSION: Children with traumatic pancreatic ductal injury can be safely managed per the PTS NOM clinical pathway and most recover rapidly. Pancreatic ascites may predict pseudocyst formation.

LEVELS OF EVIDENCE: IV.

STUDY TYPE: therapeutic, comparative.

Journal Title

Journal of pediatric surgery

Volume

60

Issue

1

First Page

161976

Last Page

161976

MeSH Keywords

Humans; Child; Adolescent; Prospective Studies; Male; Female; Child, Preschool; Pancreatic Ducts; Wounds, Nonpenetrating; Infant; Pancreas; Length of Stay; Pancreatectomy; Diet, Fat-Restricted; Treatment Outcome; Stents; Abdominal Injuries

PubMed ID

39442331

Keywords

Children; Clinical pathway; Non-operative management; Outcomes; Pancreatic trauma; Pediatric

Comments

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