[size=20px]A 3-year-old child was stepped on by a Great Dane yesterday and now has abdominal pain but is hemodynamically stable and afebrile. An abdominal CT scan demonstrates a complete distal pancreatic transection. The best management strategy for this patient is:

 

A Distal pancreatectomy

 

B Endoscopic pancreatography and trans-ductal stent placement

 

C Endoscopic trans-gastric drainage of the fluid collection

 

D NPO with TPN and analgesics[/size]

A

A

D

D

Correct answer

A Distal pancreatectomy

 

When the pancreas is transected distal to the head and a patient presents within 48-72 hours, distal pancreatectomy is very successful and is associated with more rapid feeding and hospital discharge. Expectant management is associated with a substantial risk for development of a pseudocyst and a protracted hospital stay but is usually necessary in cases with a delayed presentation. Endoscopic pancreatic ductal stenting is increasingly favored in adults with pancreatic transections, particularly if the stent may be placed beyond the site of injury. This approach is reasonable for children over about 10 years of age if appropriate equipment and expertise is available.