Nonoperative management of grade III pancreatic injuries in children: a case series

Pediatric American Association for the Surgery of Trauma (AAST) Grade III pancreatic injuries—complete transections of the main pancreatic duct (MPD)—are rare, and long-term outcomes following nonoperative management are not well defined. Three hemodynamically stable children with American Association for the Surgery of Trauma (AAST) Organ Injury Scale (OIS) grade III pancreatic injuries were managed nonoperatively ( nil per os, total parenteral nutrition, protease inhibitor therapy, and analgesia. Case 1 (male, injured at age 10) had early MRCP (day 3) confirming MPD transection; MRCP was repeated at 6 months and 1 year; distal pancreatic atrophy was first detected at 2 years 3 months and remained stable at 7 years 11 months. Case 2 ( female, injured at age 14) had early MRCP (day 5) confirming MPD transection; MRCP was repeated at 6 months and 1 year; distal atrophy was first detected at 1 year 9 months and persisted at 6 years 2months. Case 3 (male, injured at age 10) had early MRCP (day 7) confirming MPD transection; subsequent MRCPs at 1 month, 8 months, 1 year 10 months, and 2 years 11months were unremarkable, without atrophy. No patient developed clinically evident endocrine or exocrine insufficiency during follow-up. Atrophy of the distal pancreas can developed in children who sustained grade-III pancreatic injuries that were managed non-operatively. Long-term pancreatic functional assessment is recommended.