An 8 year-old girl presents to the Emergency Department two days after a handlebar injury to the upper abdomen while riding her bike. She has significant abdominal pain with tenderness in the epigastric area. She is hemodynamically stable and afebrile. Serum lipase is >10,000 units/L. An abdominal CT scan demonstrates a deep laceration to the pancreatic body with possible transection of the main pancreatic duct. Management options for this patient include:

 

A Spleen-preserving distal pancreatectomy

 

B Pain control, NPO and TPN

 

C Endoscopic retrograde pancreatography (ERCP) and pancreatic stent insertion

 

D All of the above​

C

C

C Endoscopic retrograde pancreatography (ERCP) and pancreatic stent insertion

D the question said management options

not just the next step , so any option may not succe so the others are available.

Edited December 27, 20223 yr by Dr.bara

Correct answer

D All of the above​​

 

The management of high grade pancreatic injuries in children is controversial. Decision-making should be based on the location of the injury (i.e. pancreatic body versus head), whether the pancreatic duct appears to be involved, and timing of presentation to hospital (i.e. less than or greater than 48 to 72 hours). There are no definitive guidelines on the management of these injuries and the long-term outcomes associated with each management option remain uncertain.

 

Spleen-preserving distal pancreatectomy can be considered when the injury is located in the body of the pancreas, the pancreatic duct is involved, and the patient presents to hospital within 48-72 hours. This strategy may be associated with decreased risk of pseudocyst formation, faster return to full diet, and decreased length of stay. Non-operative management is necessary in cases of delayed presentation or injuries to the pancreatic head.

 

Endoscopic retrograde pancreatography (ERCP) with ductal stenting is increasingly favored in adults with high grade pancreatic injuries, particularly if the stent can be placed beyond the site of injury. A trial of endoscopic management is a reasonable option if appropriately-sized equipment and expertise are available on an urgent basis.

 

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