Non-operative versus operative management of high-grade pancreatic trauma in children: lessons from a Belgian long-term follow-up cohort.

UNLABELLED: Pancreatic trauma in children is rare but may result in severe complications, particularly in injuries involving duct transection. Optimal management-surgical versus conservative-remains debated. We aimed to compare long-term complications between both management approaches. This multicenter retrospective and prospective study analyzed children (< 18 years) with grade III-V pancreatic trauma treated between 2009 and 2019 at Belgian Level 1 trauma centers. Patient characteristics, management, and outcomes were assessed with long-term follow-up. Among 31 patients, 35% underwent surgery and 65% were managed conservatively. Pseudocyst formation was significantly higher in the non-operative group (85%) vs. surgical (18%, p = 0.0013). Long-term complications included pancreatic atrophy (35%), recurrent pancreatitis (19%), and exocrine dysfunction; no endocrine insufficiency was reported.

CONCLUSION

Surgical and conservative management of grade III and IV trauma are safe for pediatric pancreatic trauma, though pseudocysts are common in the conservative approach and often require endoscopic drainage. Ongoing follow-up is essential to monitor for long-term complications such as pancreatitis and pancreatic atrophy.

WHAT IS KNOWN: • Non-operative management of pancreatic trauma with complete duct transection is associated with a higher risk of pseudocyst formation compared with operative management. • Long-term comparative studies on outcomes of patients with pancreatic trauma and complete pancreatic duct transection are scarce, limited in time, and often retrospective.

WHAT IS NEW: • Regardless of the initial management, children with grade III, IV, and V pancreas trauma are at risk to develop very long-term complications such as pancreatitis, pancreas atrophy, and exocrine insufficiency; clinical follow-up is therefore warranted.