Management of blunt pancreatic injury in children

Background and Methods: Controversy persists regarding the management of pancreatic transection. Over the past 10 years, 51 patients admitted to the Children's Hospital of Pittsburgh sustained blunt pancreatic injuries. We reviewed their medical records to clarify the optimal management strategy and to define distinguishing characteristics, if any, of patients with pancreatic transection. Results: Patients who sustained pancreatic transection had a significantly higher Injury Severity Score, length of stay., serum amylase, and serum lipase, than those patients who sustained pancreatic contusion. Patients who underwent laparotomy within 48 hours of injury for pancreatic transection had a significantly shorter length of stay than those who underwent laparotomy more than 48 hours after injury. Conclusion: Serum amylase greater than 200 and serum lipase greater than 1,800 may be useful clinical markers fur major pancreatic ductal injury when combined with physical examination, Early operative intervention for pancreatic transection results in shorter length of stay and fewer complications.