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Shaikh IR, Rahmat ZS, Islam Z, Khan MAM, Ali SW, Nasir S, Mousavi SH. Trivial injury with devastating complication-A case of pediatric pancreatic pseudocyst. Clin Case Rep 2023; 11:e7271. [PMID: 37273671 PMCID: PMC10233369 DOI: 10.1002/ccr3.7271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/24/2023] [Accepted: 04/12/2023] [Indexed: 06/06/2023] Open
Abstract
Key Clinical Message Pancreatic pseudocysts are rare in the pediatric population, commonly a result of trauma. Timely diagnosis and adequate management with a multidisciplinary approach are the key to avoid morbidity and mortality. Larger cysts often require surgical intervention. Abstract We report a case of a 4-year-old female child who presented with a massive pancreatic pseudocyst. Pseudocysts >10 cm are at an increased risk of rupture, hence require surgical intervention. Percutaneous external drainage via pigtail catheter was followed by cysto-gastrostomy due to continuous high output. The postoperative period was uneventful.
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Affiliation(s)
- Iqra Rehman Shaikh
- Department of PediatricsDow University of Health Sciences, Dr. RKMP Civil Hospital KarachiKarachiPakistan
| | - Zainab Syyeda Rahmat
- Department of PediatricsDow University of Health Sciences, Dr. RKMP Civil Hospital KarachiKarachiPakistan
| | - Zarmina Islam
- Department of PediatricsDow University of Health Sciences, Dr. RKMP Civil Hospital KarachiKarachiPakistan
| | - Mohammad Arif Mateen Khan
- Department of Pediatric surgeryDow University of Health Sciences, Dr. RKMP Civil Hospital KarachiKarachiPakistan
| | - Syed Waqas Ali
- Department of Pediatric surgeryDow University of Health Sciences, Dr. RKMP Civil Hospital KarachiKarachiPakistan
| | - Sharmeen Nasir
- Department of PediatricsDow University of Health Sciences, Dr. RKMP Civil Hospital KarachiKarachiPakistan
| | - Sayed Hamid Mousavi
- Medical Research CenterKateb University, Kabul, Afghanistan, Afghanistan National Charity Organization for Special Diseases (ANCOSD)KabulAfghanistan
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Minimally Invasive Approaches for Traumatic Rupture of the Pancreas in Children—A Case Series. CHILDREN 2022; 9:children9081102. [PMID: 35892605 PMCID: PMC9329767 DOI: 10.3390/children9081102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/13/2022] [Accepted: 07/18/2022] [Indexed: 11/18/2022]
Abstract
Pancreatic trauma in children is rare; therefore, both scientific knowledge and clinical experience regarding its management are limited. Abdominal sonography and subsequent computed tomography (CT) imaging are the diagnostic mainstay after severe abdominal trauma in many pediatric trauma centers. However, the diagnosis of pancreatic injury is missed on the initial imaging in approximately one third of cases, with even higher numbers in young children. While conservative treatment is preferred in low-grade injuries, surgical interventions may be indicated in more severe injuries. We present a case series including four patients with high-grade pancreatic injury. Two patients were treated surgically with open laparotomy and primary suture of the head of the pancreas and pancreatico-enterostomy, one patient underwent endoscopic stenting of the pancreatic duct and one received conservative management including observation and secondary endoscopic treatment. We want to emphasize the fact that using a minimally invasive approach can be a feasible option in high-grade pancreatic injury in selected cases. Therefore, we advocate the necessity of fully staffed and equipped high-level pediatric trauma centers.
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Chylous ascites and pancreatic pseudocyst on a child following blunt abdominal trauma; a case report. Int J Surg Case Rep 2022; 97:107406. [PMID: 35839653 PMCID: PMC9403079 DOI: 10.1016/j.ijscr.2022.107406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Chylous ascites is the collection of milky-like fluid rich in triglycerides within the peritoneal cavity. It results from disruption of normal intestinal lymphatic flow. It is caused mainly by congenital anomalies, trauma, and malignancy. Chylous ascites following blunt abdominal injury is uncommon in pediatrics. Chyle duct and pancreatic injuries present a rare clinical sequela yet to be reported in the literature. Conservative management is the mainstay of treating chyle duct injuries, reserving invasive measures for unique circumstances. CASE PRESENTATION A case of an eleven-year-old female who suffered blunt thoracoabdominal trauma and sustained injuries to the chest, pancreas, and chyle duct. She had clinical signs of peritonism and decreased air entry on the right hemithorax. While she underwent abdominal exploration, the chylous ascites eventually resolved on conservative management, and the pancreatic pseudocyst was later drained percutaneously. DISCUSSION Chylous ascites and pancreatic pseudocyst is uncommon in pediatrics. While surgery is indicated in selected cases, a conservative approach is advocated in managing lymphatic leaks. Diet with low triglycerides and high protein is advocated to decrease lymph production. Treatment of pancreatic pseudocyst varies from conservative (watchful waiting) to drainage measures. CONCLUSION Although chylous ascites is not expected following trauma, has to be considered among differential free peritoneal fluid. Pancreatic injuries are common but difficult to diagnose. CT and MRCP are preferred modalities for diagnosing pancreatic injuries. While dietary modification and drainage of the chylous ascites were the mainstays in managing chyle duct injury, pancreatic pseudocyst resolved after percutaneous drainage.
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Jaiswal V, Naz S, Ishak A, Batra N, Quinonez J, Mukherjee D, Pokhrel NB. A rare case of pediatric pancreatic pseudocyst. Clin Case Rep 2022; 10:e05879. [PMID: 35600019 PMCID: PMC9107915 DOI: 10.1002/ccr3.5879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/26/2022] [Accepted: 04/22/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Sidra Naz
- BIDMC Harvard Medical School Boston Massachusetts USA
| | - Angela Ishak
- Larkin Community Hospital South Miami Florida USA
| | - Nitya Batra
- Maulana Azad Medical College New Delhi India
| | - Jon Quinonez
- Larkin Community Hospital South Miami Florida USA
| | | | - Nishan Babu Pokhrel
- Department of Internal Medicine Tribhuvan University Institute of Medicine Maharajgunj Nepal
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Haggenmüller B, Kloth C, Gräter T, Schmidt SA, Beer M, Appelt F, Formentini A, Nasir N, Vogele D. [Space-occupying lesion of the pancreaticoduodenal junction after blunt abdominal trauma in a young patient]. Radiologe 2021; 62:51-56. [PMID: 34524481 DOI: 10.1007/s00117-021-00915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- B Haggenmüller
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - C Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T Gräter
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - S A Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - F Appelt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - A Formentini
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - N Nasir
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - D Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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Zhang D, Yan J, Siyin ST, Pang W, Chen Y. Nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children: a single center's experience. BMC Pediatr 2021; 21:75. [PMID: 33573611 PMCID: PMC7877105 DOI: 10.1186/s12887-021-02535-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background The treatment of high-grade (III/IV/V) blunt pancreatic injuries remains controversial. The study aims to summarize and evaluate nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children. Methods Twenty children [6.9 (3–12) years] treated at our center between January 2010 and June 2018 were included in this study. Their medical records and the outpatient follow-up data within 12 weeks after discharge were retrospectively reviewed. Long-term follow-up was conducted by telephone in February 2020. Results Nine children developed complications, including 8 pancreatic pseudocysts and 1 abdominal infection, after treatment at external hospitals and were transferred to our center with an average length of stay of 33.8 (8–63) days. Eleven children were admitted to our hospital directly after injury, with an average length of stay of 47.5 (23–69) days. One child underwent emergency laparotomy for hemorrhagic shock and Roux-en-Y drainage of the distal pancreas. The remaining 10 children received conservative treatment: 7 developed pancreatic pseudocysts, 2 developed abdominal infections, and 1 recovered uneventfully. For children with pancreatic pseudocysts (15/20, 75.0%), 4 recovered after conservative treatment, 4 recovered after percutaneous puncture, 5 recovered after external drainage of the cyst, and 2 recovered after alimentary tract anastomosis. Three children (3/20, 15.0%) who developed abdominal infection recovered after abdominal irrigation and drainage. No child was admitted to the ICU or died. Four children (4/20, 20.0%) developed local pancreatic atrophy within 12 weeks after discharge, but no other long-term complications were observed. Conclusions Nonresection management of the pancreas could be a feasible option for children with grade III and IV blunt pancreatic injuries. Regular long-term follow-up is essential in terms of pancreatic function, especially in patients with pancreatic atrophy.
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Affiliation(s)
- Dan Zhang
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Sarah Tan Siyin
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China. .,, Beijing, People's Republic of China.
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Duggan W, Hannan E, Brosnan C, O'Sullivan S, Conlon K. Conservative management of complete traumatic pancreatic body transection; A case report. Int J Surg Case Rep 2020; 71:222-224. [PMID: 32480329 PMCID: PMC7262372 DOI: 10.1016/j.ijscr.2020.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022] Open
Abstract
Pancreatic trauma is associated with considerable morbidity and mortality. Traditionally, cases that involved injury to the pancreatic duct were almost always managed operatively. Much of the morbidity and mortality associated is related to operative complications. This case highlights that where possible, in instances where there is no bile leak or active haemorrhage, a conservative management approach may be safe and effective.
Introduction Isolated pancreatic body transection secondary to blunt abdominal trauma is a very rare injury associated with poor outcomes. Almost all previously reported cases were managed by emergency distal pancreatectomy, which is associated with high morbidity and mortality. To our knowledge, this is the first reported case of complete transection of the pancreas at the body that was successfully treated by conservative management in an adult patient. Presentation of case A 19-year-old male was found to have complete transection of the pancreatic body on computed tomography (CT) following blunt force abdominal trauma. Given that he was haemodynamically stable without evidence of haemorrhage or bile leakage on imaging, a trial of conservative management was initiated. He remained well through his admission, gradually improving clinically and biochemically with stable appearances on serial imaging. He remains asymptomatic as of six months since discharge from the hospital and continues to be monitored in the outpatient setting. Discussion Management of pancreatic trauma with ductal injury has typically been with emergency distal pancreatectomy, which is associated with high morbidity and mortality. The decision to operate should not be purely based on radiological findings, and should take into account clinical status, haemodynamic stability, coexisting injuries and evidence of active haemorrhage or bile leak. Conclusion In select cases, it is reasonable to trial conservative management in isolated traumatic pancreatic body fracture by means of close clinical observation and serial imaging. This may allow the patient to avoid a high-risk emergency distal pancreatectomy.
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Affiliation(s)
- W Duggan
- St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland.
| | - E Hannan
- St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland
| | - C Brosnan
- St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland
| | - S O'Sullivan
- St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland
| | - K Conlon
- St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland
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Marks RM, Potter DD. Delayed endoscopic management of a high-grade common bile duct injury: A case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Pediatric ultrasonography of the pancreas: normal and abnormal findings. J Ultrasound 2018; 22:261-272. [PMID: 30552664 DOI: 10.1007/s40477-018-0348-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/04/2018] [Indexed: 12/11/2022] Open
Abstract
The pancreas is easily investigated in children thanks to the relative lack of fat tissue and the large left hepatic lobe with an optimal acoustic window. The use of high frequency, even linear transducers, usually results in detailed images of all pancreatic areas. A wide spectrum of pancreatic pathologic conditions can be identified and monitored at ultrasound although they are relatively uncommon during childhood compared to the adult. In this paper we briefly review the anatomy, technique, and sonographic aspects of normal and pathological pediatric pancreas.
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