Journal of pediatric surgery · 2010
Operative vs nonoperative management of blunt pancreatic trauma in children.
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Wood James H, Partrick David A, Bruny Jennifer L, Sauaia Angela, Moulton Steven L
Аннотация
PURPOSE: The aim of this study was to evaluate the outcome of nonoperative vs operative management of blunt pancreatic trauma in children.
METHODS: Retrospective review of pancreatic injuries from 1995 to 2006 at an urban level I regional pediatric trauma center.
RESULTS: Forty-three children with pancreatic injury were included in the analysis. Injuries included grade I (n = 18), grade II (n = 6), grade III (n = 17), and grade IV (n = 2). For grade II to IV injuries, patients managed operatively (n = 14) and nonoperatively (n = 11) had similar lengths of stay and rates of readmission, despite increased pancreatic complications (PCs) in the nonoperative cohort (21% vs 73%; P = .02). There was a trend toward increased non-PCs in patients managed with resection (P = .07). Twelve patients underwent successful diagnostic endoscopic retrograde cholangiopancreatography in which duct injury was identified. In this group, nonoperative management was pursued in 6 patients but was associated with increased rates of PC (86% nonoperative vs 29% operative; P = .02).
CONCLUSIONS: Operative management of children with grades II to IV pancreatic injury results in significantly decreased rates of PCs but fails to decrease length of stay in the hospital, possibly as a result of non-PCs. Endoscopic retrograde cholangiopancreatography may serve as a useful diagnostic modality for guiding operative vs nonoperative management decisions.
METHODS: Retrospective review of pancreatic injuries from 1995 to 2006 at an urban level I regional pediatric trauma center.
RESULTS: Forty-three children with pancreatic injury were included in the analysis. Injuries included grade I (n = 18), grade II (n = 6), grade III (n = 17), and grade IV (n = 2). For grade II to IV injuries, patients managed operatively (n = 14) and nonoperatively (n = 11) had similar lengths of stay and rates of readmission, despite increased pancreatic complications (PCs) in the nonoperative cohort (21% vs 73%; P = .02). There was a trend toward increased non-PCs in patients managed with resection (P = .07). Twelve patients underwent successful diagnostic endoscopic retrograde cholangiopancreatography in which duct injury was identified. In this group, nonoperative management was pursued in 6 patients but was associated with increased rates of PC (86% nonoperative vs 29% operative; P = .02).
CONCLUSIONS: Operative management of children with grades II to IV pancreatic injury results in significantly decreased rates of PCs but fails to decrease length of stay in the hospital, possibly as a result of non-PCs. Endoscopic retrograde cholangiopancreatography may serve as a useful diagnostic modality for guiding operative vs nonoperative management decisions.
Предметные рубрики MeSH
Abdominal InjuriesAdolescentAge FactorsChildChild, PreschoolCholangiopancreatography, Endoscopic RetrogradeFemaleFollow-Up StudiesHumansInfantMalePancreasPancreatectomyPancreatic DiseasesParenteral Nutrition, TotalPostoperative ComplicationsTomography, X-Ray ComputedTrauma CentersTrauma Severity IndicesTreatment OutcomeWounds and InjuriesWounds, Nonpenetrating