Pancreatic injuries in childhood due to blunt trauma.

The records of 22 children who suffered pancreatic injury in whom laparotomy confirmed the diagnosis were reviewed. First, we wished to define diagnostic factors that would distinguish transections and injuries that resulted in pseudocysts (which we termed major injuries) from contusions and lacerations that required no specific operation (minor injuries). Second, we wanted to determine how the timing of diagnosis and treatment of major injuries influenced hospital course. There were 13 major injuries (ten transections, three pseudocysts) and nine minor injuries. Abdominal tenderness (present in 83%) failed to distinguish major from minor injuries. Major injuries appeared to be associated with rising values of serum amylase taken serially over 24 to 48 hours (P = .05). Computerized tomography and ultrasound obtained in the first days after injury gave nonspecific findings and failed to give a definitive diagnosis. Of 13 patients with major injuries, seven underwent laparotomy within 24 hours of injury; six, two days or more. The mean hospital stay in the early group (16.7 days) was significantly shorter than that in the late group (38.8 days). Our review suggests that timely diagnosis of major pancreatic injuries and prompt surgical treatment can shorten hospitalization without increasing morbidity. The diagnosis of surgically significant pancreatic injuries continues to be a primary clinical challenge.