Pancreatic stent and transpapillary pseudocyst drainage via endoscopic retrograde cholangiopancreatography for children with blunt pancreatic duct injury

BACKGROUND: Nonoperative management (NOM) in blunt pancreatic injury (BPI) is frequently complicated by pseudocyst formation and pancreatic atrophy. To address these complications, we have utilized a pancreatic stent via endoscopic retrograde cholangiopancreatography (ERCP) for children with PDI since 2019. AIM: We present our experience with ERCP-based NOM for PDI and provide a literature review of stent therapy in pediatric PDI. MATERIALS AND METHODS: Ten children with BPI treated between January 2007 and December 2025 were classified according to the 2024 American Association for the Surgery of Trauma pancreatic injury grades: IB (n = 3), IIA (n = 3), IIIA (n = 2), and IIIB (n = 2). Pancreatic stents were placed in two IIIA cases and one IIIB case. The IIIB case subsequently underwent transpapillary pseudocyst drainage (TPPD) due to a pseudocyst infection. RESULTS: NOM was successful in all low-grade injuries (< II) without complications. One IIIB patient treated without stenting developed a pseudocyst requiring cyst-gastrostomy; 1-year follow-up demonstrated severe pancreatic atrophy. In the two IIIA stent cases, the duct injury was successfully bridged: one patient had no pseudocyst formation, and the other developed a pseudocyst that resolved spontaneously; both showed preserved pancreatic parenchyma. The IIIB patient treated with TPPD experienced rapid cyst resolution; 1-year imaging revealed approximately 50% distal pancreatic atrophy. CONCLUSION: TPPD should be considered for symptomatic pseudocysts, even after stent placement. ERCP-based NOM for pediatric PDI can be performed safely, may prevent pancreatic atrophy, and represents a valuable option in the management of PDI in children.