Journal of pediatric surgery最新文献

{"title":"Contemporary Ethical Considerations for Pediatric Metabolic and Bariatric Surgery.","authors":"Marla A Sacks, Catherine Hunter, Patrick J Javid, Baddr A Shakhsheer","doi":"10.1016/j.jpedsurg.2024.161988","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161988","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of pediatric obesity continues to increase dramatically. Though metabolic and bariatric surgery (MBS) is efficacious and is supported by high-quality data in this population, it remains underutilized. This paper aims to discuss current ethical concerns, considerations, and controversies of pediatric MBS.</p><p><strong>Methods/results: </strong>Three case studies are utilized to illustrate ethical issues related to pediatric MBS: 1) a teenager with obesity and an unsupportive parent; 2) a teenager with morbid obesity and developmental delay; and 3) a young child with severe liver damage from hepatic steatosis.</p><p><strong>Conclusions: </strong>The prevalence of pediatric obesity is rising exponentially with more cases resistant to lifestyle modifications and medical therapies. Metabolic and bariatric surgery (MBS) in children is efficacious and should prompt thoughtful multi-disciplinary discussion to best help the patient regardless of racial, ethnic, or socioeconomic status. Decision making involves consideration of patient assent, parent/guardian consent, and balance of current and future risk. Providers caring for patients should utilize \"obesity-friendly\" language to lessen stigma.</p><p><strong>Level of evidence: </strong>Level V.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"161988"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cloacal Exstrophy Closure Without Osteotomy and Immobilization: A Recipe for Failure","authors":"David Heap ,&nbsp;Ahmad Haffar ,&nbsp;Chad B. Crigger ,&nbsp;Tanisha Martheswaran ,&nbsp;Alexander Hirsch ,&nbsp;Victoria Maxon ,&nbsp;Paul D. Sponseller ,&nbsp;Heather N. Di Carlo ,&nbsp;John P. Gearhart","doi":"10.1016/j.jpedsurg.2024.161995","DOIUrl":"10.1016/j.jpedsurg.2024.161995","url":null,"abstract":"<div><h3>Background</h3><div>Cloacal exstrophy (CE) remains one of the most severe birth defects compatible with life with a constellation of anomalies involving the bladder, genitalia, hindgut, and spinal cord. Pelvic osteotomy and immobilization have been utilized to facilitate bladder closure, yet their role as adjuncts remains a topic of debate. The authors sought to evaluate the outcomes of CE closure without the use of osteotomy or lower extremity (LE)/pelvic immobilization.</div></div><div><h3>Methods</h3><div>An institutional database of 173 CE patients was reviewed for patients closed without osteotomy and/or limb immobilization. Patient records were reviewed for continence procedures, reclosure operations, and continence outcomes.</div></div><div><h3>Results</h3><div>A total of 59 closure surgeries that met inclusion criteria were identified in 56 unique patients. Thirty-seven closure procedures developed eventual failure (63%) with secondary closure events also resulting in failure. Most closures did not use an osteotomy, 93.2%. LE immobilization-only was used in most closures (43/59), of which only 37% were successful. Failures were attributed to dehiscence (14/37), bladder prolapse (19/37), or both dehiscence and prolapse (4/37). The median age at closure was 3 days old (1–18.5 IQR) with the majority of closure events (47) closure events taking place in the newborn period. Median diastasis prior to primary closure was 6 cm (4.8–8 cm IQR). The median number of closure attempts needed to close the bladder was 2 (1–2 IQR). Of the 56 patients, 31 have &gt;3 h of daytime continence, with the entirety of these patients catheterizing a stoma or below.</div></div><div><h3>Conclusion</h3><div>These results highlight the critical role of osteotomy and lower limb immobilization in successful closure of the bladder and abdominal wall in CE.</div></div><div><h3>Type of Study</h3><div>Treatment Study.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 1","pages":"Article 161995"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of External Ventricular Drains for Neuromonitoring and Traumatic Brain Injury Treatment in Pediatric Patients Outside of Intensive Care Units: A Single-Institution Retrospective Study.","authors":"Matthew C Findlay, Katie W Russell, Samuel A Tenhoeve, Monica Owens, Rajiv R Iyer, Robert J Bollo","doi":"10.1016/j.jpedsurg.2024.161993","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161993","url":null,"abstract":"<p><strong>Background: </strong>Most pediatric hospitals manage patients who require external ventricular drains (EVDs) exclusively within pediatric intensive care units (PICUs) because of institutional protocols. Our institution commonly manages patients with EVDs on the neurotrauma floor (NTF). We evaluated whether this practice results in more EVD-associated complications.</p><p><strong>Methods: </strong>A retrospective cohort study at our Level 1 pediatric trauma center identified all trauma patients ≤18 years old who received an EVD in 2018-2023. Demographics, presenting characteristics, in-hospital management, and EVD management details were recorded. The primary outcome was EVD-related complication events.</p><p><strong>Results: </strong>Of the 81 patients who had EVDs placed after neurotrauma, 45 had their EVD managed exclusively in the PICU (PICU-EVD) and 36 had their EVD for some time while on the NTF (NTF-EVD). The groups were similar in sex (p = 0.87) and age (p = 0.054). PICU-EVD patients underwent fewer neurosurgeries (55.6% vs. 77.8%, p = 0.04) but spent more time on ventilators (10.6 ± 8.7 days vs. 6.4 ± 4.8, p = 0.02) and in the PICU (11.8 ± 9.0 days vs. 8.4 ± 5.9, p = 0.02). Total hospital stay was similar between groups (p = 0.44). NTF-EVD patients were on the drain longer (9.0 ± 7.4 days vs. 13.1 ± 9.1, p = 0.03), including 5.9 days on the NTF. Four EVD-related complications occurred overall: 2 accidental dislodgements and 2 cerebrospinal fluid leaks. EVD complication rates were similar on the NTF and PICU (2.2% vs. 8.3%, p = 0.21). All complications occurred late in the hospital course and were minor. A Poisson regression model comparing complication rates between PICU-only and NTF management (433 vs. 441 catheter days, respectively) found a complication rate of 6.8 per 1000 catheter days in the NTF group versus 2.3 per 1000 catheter days in the PICU-only group, yielding a rate ratio of 2.95 (95% confidence interval 0.29-30.4, p = 0.35). However, this difference was not statistically significant.</p><p><strong>Conclusion: </strong>Our center routinely discharges patients from the PICU to the NTF with EVDs in place. This practice may be associated with no increased risk or rate of EVD-related complications compared to PICU-only management.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"161993"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SIPA Poorly Predicts Outcomes in Young Pediatric Trauma Patients","authors":"Katherine B. Snyder ,&nbsp;Ryan Phillips ,&nbsp;Kenneth Stewart ,&nbsp;Zoona Sarwar ,&nbsp;Catherine J. Hunter ,&nbsp;Alessandra Landmann ,&nbsp;Roxie Albrecht ,&nbsp;Jeremy Johnson","doi":"10.1016/j.jpedsurg.2024.161997","DOIUrl":"10.1016/j.jpedsurg.2024.161997","url":null,"abstract":"<div><h3>Introduction</h3><div>The shock index pediatric adjusted score (SIPA) predicts the need for blood transfusion (BT), hemorrhage control interventions (HCI), morbidity/mortality among older pediatric trauma patients but is less predictive in younger patients. We hypothesize that SIPA will be predictive among older pediatric patients for BT, HCI, mortality, and need for trauma intervention (NFTI), however we aim to further delineate the gap in utilizing SIPA in younger patients.</div></div><div><h3>Methods</h3><div>Using the ACS NTDB for 2017–2021 we evaluated patients 1–14 years old who were transported by EMS from the scene for definitive care. Patients were divided into three age groups: 1–4, 5–9, and 10–14 years. Recursive partitioning was used to identify separate SIPA cut-points predictive of BT, HCI, NFTI, and morbidity/mortality. Cut-points from the partitions were evaluated using Area-under-curve (AUC) statistics and response probabilities were obtained from corresponding Leaf Reports.</div></div><div><h3>Results</h3><div>Four SIPA cut-points from the recursive partitioning were selected for each age group. SIPA was more predictive of the need for HCI. BT showed similar results consistent with previous literature. SIPA alone showed poor discrimination in relation to NFTI and mortality, and again predictive value was slightly higher in older children.</div></div><div><h3>Conclusion</h3><div>While SIPA alone showed discrimination of specific outcomes of BT and HCI, it was poorly predictive of both the NFTI and mortality in children. The youngest pediatric patients continue to be elusive. Utilizing SIPA in combination with additional scores may be necessary to triage young children appropriately. This study also indicates the need to develop NFTI criteria specific to children.</div></div><div><h3>Level of Evidence</h3><div>IV.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 1","pages":"Article 161997"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thoracoscopic Lobectomy for Congenital Lung Malformation in Children: Evolving Management Strategies and Their Impact in Outcomes","authors":"María López-Diaz ,&nbsp;Indalecio Cano Novillo ,&nbsp;Rocío Morante-Valverde ,&nbsp;Araceli García Vázquez ,&nbsp;Manuel Romero Layos ,&nbsp;Alberto Galindo Izquierdo ,&nbsp;Juan L. Antón-Pacheco","doi":"10.1016/j.jpedsurg.2024.161992","DOIUrl":"10.1016/j.jpedsurg.2024.161992","url":null,"abstract":"<div><h3>Background</h3><div>The aim of this study was to determine the incidence of complications after thoracoscopic lobectomy in children according to a verified classification. Secondary aim was to evaluate the modifications made in our management protocol in order to decrease the rate of complications.</div></div><div><h3>Methods</h3><div>Retrospective study of pediatric patients in whom a lobectomy was performed for congenital lung malformation (CLM) in our institution between 2003 and 2021. The following data were collected: demographics, preoperative clinical symptoms, surgical technical details, and postoperative complications following the Clavien-Dindo (CD) classification. Main outcome measure was the presence of complications in the first month after lung lobectomy.</div></div><div><h3>Results</h3><div>90 lobectomies were performed in 89 patients. There were 46 girls (51.6%) and 43 boys with a median age of 12.4 months. Most patients (86.6%) remained asymptomatic until the surgical procedure. Postsurgical complications were detected in 26 cases (28.8%) and distributed into their respective category according to CD classification. In our experience, closure of the bronchial stump with interrupted suture or placement of an endoloop showed a statistically significant association with complications (p = 0.022 and p = 0.006 respectively). Moreover, patients in which a device combining sealing and section was used showed significantly fewer complications (p = 0.006).</div></div><div><h3>Conclusions</h3><div>Thoracoscopic lobectomy continues to be a challenging procedure. The CD grading system for postoperative complications has proved to be useful in this setting. Evolving surgical strategies and new miniaturized endosurgical devices have enabled a safer and quicker procedure with a positive impact in the development of complications.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 1","pages":"Article 161992"},"PeriodicalIF":2.4,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Preoperative Intrahepatic Portal Venous Classification System in Guiding Preoperative Surgical Decisions and Predicting Hypotensive Effects After Meso-rex Bypass for Children With EHPVO.","authors":"Xiaopan Chang, Lu Liu, Jieqin Wang, Qifeng Liang, Jiankun Liang, Zhenyin Liu, Zhe Wen","doi":"10.1016/j.jpedsurg.2024.161990","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161990","url":null,"abstract":"<p><strong>Background: </strong>The categorization of intrahepatic portal venous system (IHPS) patterns using wedged hepatic venous portography (WHVP) has proven to be an effective tool in the preoperative evaluation of Rex recessus and in identifying pediatric patients with extrahepatic portal vein obstruction (EHPVO) who are suitable for meso-Rex bypass (MRB). Despite this classification system being proposed a decade ago, its clinical application remains underutilized.</p><p><strong>Methods: </strong>A single-center retrospective study of 182 children with EHPVO was conducted between October 2014 and July 2023 when MRB was attempted. Data on demographics, etiology, imaging examinations, procedures, and follow-up were collected for 161 patients included. Two interventional radiologists used deVille's method to classify patients into types A to E based on WHVP imaging, with interobserver agreement analyzed. Associations between IHPS patterns and surgical outcomes following MRB were investigated.</p><p><strong>Results: </strong>Two radiologists had a high level of agreement on identifying IHPS patterns and suitable patients for MRB. Of the 161 cases, 130 were type A, 10 were type B, 5 were type C, 7 were type D, and 9 were type E. One hundred and forty-five patients with types A, B and C underwent successful MRB, showing feasibility for 90% of patients. Children categorized as types A and B experienced more significant benefits than type C, including intraoperatively decreased portal vein pressure, esophageal/gastric varices relief, decreased portal venous collaterals and a lower rate of bypass occlusion after one year. The surgical outcomes of patients with types A and B were not influenced by the diameter of the Rex recessus as suggested by WHVP.</p><p><strong>Conclusions: </strong>The majority of pediatric patients with EHPVO in mainland China have opportunities to receive successful MRB. There are potential differences in the etiology of Chinese and Western patients. The IHPS classification system aids in guiding preoperative surgical decisions and predicting hypotensive effects after MRB. Type C patients should be carefully chosen for MRB.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"161990"},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468262","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a National Sample of 16,671 Pediatric Burn Admissions: Identifying Predictors of Non-accidental Pediatric Burns","authors":"Samantha M. Koenig,&nbsp;Michelle S. Mathis,&nbsp;Chinwendu Onwubiko,&nbsp;Mike K. Chen,&nbsp;Elizabeth A. Beierle,&nbsp;Robert T. Russell","doi":"10.1016/j.jpedsurg.2024.161989","DOIUrl":"10.1016/j.jpedsurg.2024.161989","url":null,"abstract":"<div><h3>Background</h3><div>Burn injuries remain one of the leading causes of injury and death in children. Studies have demonstrated a higher mortality for pediatric burns associated with non-accidental injury. Using data from a burn registry, our study aimed to discern potential factors associated with non-accidental burn injuries.</div></div><div><h3>Methods</h3><div>We utilized the American Burn Association database from 2016 to 2018, which collects data from over one hundred burn centers across the United States, to evaluate a large pediatric burn population. Patients aged ≤14 years were analyzed. The population was then divided into suspected non-accidental versus accidental burn injuries. A multivariable logistic regression model was utilized to evaluate for predictors of burn injuries. Additional models were used to assess the relationship between suspected non-accidental burn injury and mortality, intensive care unit (ICU) stay, and hospital length of stay.</div></div><div><h3>Results</h3><div>16,671 pediatric patients were included. Of those, 1228 (7.4%) patients suffered non-accidental burn injury. A majority of children who sustained non-accidental burn injury were younger, non-white, and sustained scald burns. The regression model demonstrated predictors for non-accidental burn injuries included younger age, Black race, chemical/corrosion burns, government insurance, and increased total body surface area (TBSA) burn. Overall mortality for the population was 0.5%.</div></div><div><h3>Conclusion</h3><div>This evaluation of a national burn registry reveals differences in pediatric patients sustaining non-accidental burns compared to accidental burns. The findings in this study identify pediatric populations at risk for suspected non-accidental burn injuries which may assist in preparing the families for expectations after admission for a burn injury.</div></div><div><h3>Level of Evidence</h3><div>III.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 1","pages":"Article 161989"},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APSA Coaching Program.","authors":"Rebecca A Saberi, Eunice Y Huang, Kerri Palamara, Holly L Neville, Terry Buchmiller","doi":"10.1016/j.jpedsurg.2024.161987","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161987","url":null,"abstract":"","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"161987"},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142546069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Podium to Publication: An Analysis of Papers Presented at the British Association of Paediatric Surgeons (BAPS) Congress (2009-19).","authors":"Ayman Goneidy, Alexander Macdonald, Mark Davenport","doi":"10.1016/j.jpedsurg.2024.161986","DOIUrl":"https://doi.org/10.1016/j.jpedsurg.2024.161986","url":null,"abstract":"<p><strong>Background: </strong>The British Association of Paediatric Surgeons (BAPS) annual congress is an opportunity to present clinical and scientific data that may influence future practice. The presentation of the Abstract is but the first step towards definitive publication in the medical literature. Our aim was to review what the success rate has been from previous congresses.</p><p><strong>Methods: </strong>Abstracts were reviewed for the 11-year-period 2009 to 2019. A MEDLINE search using keywords from title and authors' names was used to identify subsequent publication. Comparison with a previous dataset [1] (1999-2008) was also carried out. Linear data were compared for trend using Mann-Whitney-U. P ≤ 0.05 was accepted as significant. Data were expressed as median (interquartile range).</p><p><strong>Results: </strong>1061 abstracts were presented orally with 555 (52.3%) subsequently published. The number per year was 90 (81-106) compared to 81 (74-79) in 1999-2008 (P = 0.25), although with a higher number actually published thereafter [45 (32-54)% vs. 30 (27-35)%; P = 0.0003)]. Publication occurred in a wide range of journals (n = 99), with most being in the Journal of Pediatric Surgery (n = 251), albeit with a smaller proportion (49% vs. 69% formerly, P < 0.05). Overall, UK institutions contributed 52.6% (n = 558) of abstracts with 240 (43%) of them subsequently published at 19 (17-29)/year. The proportion of UK presentations had increased from 43% formerly (P = 0.016). Most UK presentations originated from institutions within London [41% vs. 45% formerly, P = 0.04]. There was a wide range of abstracts from institutions from outside of the UK (n = 49) with 38 (26-51) abstracts accepted each year and of these 62.4% were subsequently published at 20 (15-36)/year.</p><p><strong>Conclusion: </strong>There has been an increase in abstracts accepted for presentation over the period, together with a higher proportion actually reaching publication. A strong international contribution was noted which has also been maintained. London remains the primary source of abstracts and publications from within the UK, although there was a higher proportion from other UK centres noted over this period. Reference [1] Macdonald AL, Parsons C, Davenport M. Outcome of abstracts presented at the British Association of Paediatric Surgeons congresses (1999-2008). J Pediatr Surg. 2012; 47: 386-90. doi: 10.1016/j.jpedsurg.2011.09.043.</p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":" ","pages":"161986"},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Endoscopic Retrograde Cholangiopancreatography in the Diagnosis and Management of Pediatric Pancreatic Injury","authors":"R Scott Eldredge ,&nbsp;David M. Notrica ,&nbsp;Mittun Patel ,&nbsp;Erin Garvey ,&nbsp;Brie Ochoa ,&nbsp;Mark McOmber","doi":"10.1016/j.jpedsurg.2024.161962","DOIUrl":"10.1016/j.jpedsurg.2024.161962","url":null,"abstract":"<div><h3>Background</h3><div>ERCP is the gold standard for evaluating the integrity of the main pancreatic duct (MPD); however, ERCP is underutilized in evaluating MPD integrity in pediatric blunt pediatric injury. The primary aim of this study was to evaluate the discordance of cross-sectional imaging (CSI) and ERCP in children with suspected MPD injury.</div></div><div><h3>Methods</h3><div>A retrospective review of all patients age ≤18 years with CSI or clinical findings suggestive of MPD injury (MPDI) and ERCP was conducted at a level I pediatric trauma center from January 2009 to May 2023. Demographic and clinical data were collected. Pancreatic injury findings were compared between cross-sectional imaging and ERCP.</div></div><div><h3>Results</h3><div>An ERCP was performed in 28 patients with suspected MPDI with a mean age of 7 ± 4.5 years and weight of 25.0 ± 13.6 kg. Based on initial CSI, 23 patients had a suspected MPDI, and 5 had concern for MPDI based on clinical findings. ERCP differed from CSI findings in 39% of patients: 7 with CSI evidence of MPDI without injury on ERCP and 4 patients without imaging concern of MPDI but demonstrated injury on ERCP. Findings on ERCP guided surgical management in 71% (20/28) of patients due to location and completeness of MPDI. All patients without MPDI were managed nonoperatively.</div></div><div><h3>Conclusion</h3><div>Approximately 40% of patients had discordant findings between ERCP and CSI. ERCP can aide in surgical management decision making. All patients with a partial MPDI were managed with endoscopic therapy alone. ERCP should be considered when assessing a child with a suspected MPDI.</div></div><div><h3>Level of Evidence</h3><div>Level III.</div></div><div><h3>Type of Study</h3><div>Diagnostic Study.</div></div>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":"60 1","pages":"Article 161962"},"PeriodicalIF":2.4,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}