Assessing nonoperative management of blunt pancreatic trauma in children: a study of 40 cases

Abstract

Introduction: Blunt pancreatic trauma (BPT) in children is uncommon but has a high morbidity. Nonoperative management (NOM) is still very controversial. This study aimed to assess the efficacy of NOM and describe the morbidity associated with it.  Methods: We analysed retrospectively the records of 40 consecutive children hospitalized in the University Hospital of Lille for BPT treated conservatively from 1997 to 2017. Use of surgery during treatment and discovery of pancreatic morphological abnormalities after the trauma were considered cases of NOM failure. Results: Pancreatic lesions were grade I (n=15), grade II (n=5), grade III (n=19), and grade IV (n=1). The median overall length of stay (LOS) was 28.0 days [4.0 to 106.0] and the median time to refeeding after trauma was 11.5 days [2.0 to 98.0]. Main short-term complications included introduction of parenteral nutrition for a median period of 21.5 days [5.0 to 102.0] (n=30) and onset of pancreatic pseudocysts (n=18). The pseudocysts were associated with increased morbidity concerning the LOS, the time to refeeding, the introduction of parenteral nutrition and its duration. However, they received conservative first-line treatment in 80% of cases, by watchful waiting (n=4), percutaneous drainage (n=1), or endoscopic drainage (n=10). Only 15% of cases of NOM resulted in failure, with use of surgery (n=4) and/or existence of pancreatic morphological abnormalities after the trauma (n=3). No patients had clinical signs of pancreatic insufficiency by the end of follow-up. Conclusion: NOM is safe and effective for of all forms of BPT, despite the initial high morbidity associated with it. Long-term follow-up could be necessary to assess the incidental impact in cases of morphological abnormalities existing more than 6 months after the trauma.