Blunt pancreatic injury in children.

BACKGROUND: Pancreatic injuries in children are rare and most often caused by mechanisms of blunt injury. Injury to the pancreas in children may be difficult to diagnose and treat.

MATERIAL AND METHOD: The article is based on literature searches in PubMed from the last 10 years (performed on 20 October 2015 and terminating on 20 October 2016) and on the authors’ own clinical experience and knowledge of the literature.

RESULTS: The search yielded a total of 20 articles, of which 6 concerned diagnostics and 14 dealt with treatment. Pancreatic injuries are rare and constitute around 0.3 % of all injuries in children, and 0.6 % of all abdominal traumas. Pancreatic injury is the fourth most frequent abdominal organ injury in children, and most occur in the age group 5 – 18 years. A little less than one fifth are isolated injuries. Computed tomography is the first choice in diagnostics, supported by magnetic resonance cholangiopancreatography to achieve optimum sensitivity. Where findings are unclear or pancreatic duct injury is suspected, early endoscopic resonance cholangiopancreatography and stent treatment are relevant to determine pancreatic duct injury. Less severe (grade I–II) injuries are treated conservatively. The choice of surgery or conservative treatment of severe injuries (grade III–V) where the pancreatic duct is involved must be considered for each individual patient. Mortality is generally associated with other severe traumas such as head injuries and multiple organ injuries.

INTERPRETATION: Pancreatic injuries or blunt traumas are rare in children and in most cases can be managed by observation. The evidence base is scant, particularly for severe injuries.