Objectives: Trauma is the leading cause of death in children. Abdominal trauma with Injuries to the liver, spleen\r\nand kidneys are common in children and many of these injuries nowadays are treated non-operatively, where as\r\nPancreatic injuries are uncommon and its management still controversial. The aim of this study is to report the\r\noutcome of management in a series of children with pancreatic injury.\r\nMethods: Ten Children less than 10 years of age treated at our institution with pancreatic injury between the\r\nperiod of May 2000 and May 2010 and reviewed retrospectively. 8 cases admitted from the emergency room and\r\ntwo cases referred from another facility. Diagnosis made on clinical suspicion, biochemistry tests and radiological\r\nconfirmation (ultrasound and CT scan). Management was started according to the grade of Injury.\r\nResults: Seven boys and three girls aged between 2.5 and 10 years sustained pancreatic injuries: three cases\r\nhad grade I Pancreatic injury (minor contusion), three cases with grade II (major contusion without duct injury or\r\ntissue loss), two with grade III (distal transection and duct injury), one case with grade IV (proximal transection) and\r\none case with pancreatic transaction and extensive duodenal injury (grade IV with associated injury). Grade I and\r\nII injuries were successfully managed without surgery. Children with grade III injuries were treated conservatively,\r\nbut each developed a symptomatic pseudo cyst that failed to resolve with percutaneous drainage and underwent\r\nspleen-sparing distal pancreatectomy. The child with grade IV transected pancreatic neck was treated by Roux-en-Y\r\njejunostomy drainage and the last case with the Grade IV and associated duodenal injury treated with Whipple\r\nprocedure. Amylase level was normal in Grade I and II injuries and increased as the grade of injury is higher. All\r\nchildren made a full recovery. Median follow up was 45 days.\r\nConclusion: Pancreatic injuries in children are uncommon and its management still controversial, some\r\nInstitutions prefers conservative management, whereas others hold on the surgical option. Level of amylase is\r\ncorrelated with the severity of the injury when pancreatic injury is diagnosed. The management of pancreatic injuries\r\nin children depends on the grade of injury, presence of associated injuries and Hospital expertise.
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