Use of ERCP to identify the site of traumatic injuries of the main pancreatic duct in children.

Major pancreatic injuries in children are uncommon but potentially very serious. They usually occur in active young boys following characteristic accidents. Despite this they frequently go unrecognized for prolonged periods. Four patients with delayed recognition of blunt pancreatic trauma are described. The presence of pancreatic injury was identified by hyperamylasaemia in every case. Ultrasound and CT scanning were helpful in identifying pseudocysts but accurate pre-operative diagnosis of main duct disruption required endoscopic retrograde cholangiopancreatography (ERCP). Surgical treatment involved a full exploration of the lesser sac with drainage of the cyst contents and identification of the site of extravasation. Two patients with proximal duct lacerations were treated by internal drainage into a Roux-en-Y loop with the addition of a distal pancreaticojejunostomy in one case. Two patients with distal lacerations were treated by distal pancreatectomy and oversewing of the remnant. All four patients recovered and were well at follow-up. Early ERCP is the only reliable method of identifying duct injuries which require urgent surgery. It should be considered in all children with blunt pancreatic trauma.