Operative vs nonoperative management of blunt pancreatic trauma in children.
Wood et al. J Ped Surg 2010;45:401-6
This article compared the difference in outcome between operative (distal pancreatectomy) and nonoperative management of grades 2-4 pancreatic injury. Based on 42 patients with pancreatic injury (18 of whom were grade 1; not included in the analysis since non underwent operative managment) the authors noted that the main difference between these two strategies was related to the type of complications. Patients who were treated nonoperatively had a higher rate of pancreatic complications while those that were treated with a distal pancreatectomy tended to have more complications not related to the pancreas.
Another retrospective study looking at 9 patients with pancreatic trauma and complete pancreatic transection confirmed the feasibility of non operative management. 4 patients developed pseudocysts, 3 of which required drainage. Follow up CT scans on 8 of the patients showed complete atrophy of the body/tail of the pancreas.
Wales et al. J Ped Surg 2001;36:823-7
Conversely, Meier et al. noted that patients with pancreatic transection had a quicker recovery and shorter length of hospital stay when treated operatively.
Meier et al. J Ped Surg 2001;36:341-4
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