Internal drainage into an Onlay-Roux-en-Y jejunal loop in isolated pancreatic injury with ductal transection: short-term and long-term follow-up in two pediatric cases

Isolated main pancreatic duct injuries spectrum and management

BACKGROUND

We present our experience with the rare injury of isolated major pancreatic duct disruption.

METHODS

From 1997 to 2003, 3 females and 13 males whose age ranged from 4 to 46 years were identified. Stabs caused 2 and blunt trauma 14 injuries. Nine presented acutely. Delay occurred in 7 patients, 6 with pseudocysts and 1 with infected pancreatic necrosis.

RESULTS

Nine cases were managed in the acute phase: 6 by splenic-preserving distal pancreatectomy and 2 by distal pancreatico-enteric anastomosis; 1 was drained. A small pseudocyst and transient pancreatic fistula were the only complications. The 6 cases with pseudocysts were managed endoscopically. Five were stented and 1 was drained without stent. Four had resolution. Two had stent cyst migration. One required a pancreaticojejunostomy and another distal pancreatectomy. One patient died of infected pancreatic necrosis. Long-term outcome could not be assessed.

CONCLUSION

In the acute situation, resection or distal pancreatico-enteric anastomoses are attainable with low morbidity. Endoscopic pseudocyst management options are feasible, with good short-term resolution. Giant cysts may be better managed operatively.

Pancreatitis and pancreatic trauma

Many pancreatic disorders in children benefit from a multidisciplinary approach. This is especially true for acute and chronic pancreatitis which has numerous and diverse etiologies. The current management of pancreatitis is reviewed, focusing on recent advances. Children with pancreatitis must be fully investigated, not least to select out those who benefit from specific surgical interventions. The treatment of pancreas divisum, pseudocysts, and fibrosing pancreatitis deserve particular consideration. Management of pancreatic injuries involving the main pancreatic duct is both variable and controversial. Treatment should be individualized depending on the site of injury, timing of referral, presence of associated injuries, and institutional expertise.