Objectives and Study: To document the demographics,
mechanisms and outcome of traumatic pancreatitis in children
at a single large tertiary referral centre in Australia.
Methods: We undertook a 10-year retrospective audit
of children admitted to the Royal Children's Hospital
[RCH], Melbourne, Australia with a hospital coded diagnosis
which included pancreatic injury between 1993 and
2002. Data included patient demographics, source of admission,
mechanism of injury, pancreatic complications, associated
injuries, Intensive Care Unit [ICU] admission, results
of any operative findings, results of any acute computed
tomography (CT) and/or ultrasound (US) imaging of pancreas,
selected laboratory findings and length of stay.
Results: We identified two distinct groups of patients in the
91 documented cases of pancreatic trauma (median age
8.0 yr, range 0.6-15.8 yr; M:F 2.5:1.0). Fifty-nine had a
history of abdominal trauma and elevated serum lipase but no
CT or ultrasound evidence of pancreatic injury (Group A).
Thirty-two had a history of abdominal trauma, elevated
serum lipase but also had CT scan and/or ultrasound evidence
of pancreatic injury[Group B]. Patients with ''less
severe'' injury based on normal imaging had a lower initial
lipase level [Group A, median 651 U/L (interquartile range
520 - 1324) vs, Group B, 1608 U/L (interquartile range
680-3526); P = 0.005] and shorter admission time [Group A,
9.0 days (interquartile range 5.5-15.5) vs Group B, 13.4
days (interquartile range 6.8 - 23.8), P = 0.04]. There were
no differences with respect to mortality [Group A, 13.5 % vs
Group B, 12.5 %] but patients with evidence of injury on
imaging were more likely to have surgical intervention
[P = 0.0001]. The single most important overall cause of
pancreatic trauma was involvement in a motor vehicle
accident as a passenger or pedestrian. However, in children
with high-grade ductal injury, bicycle handlebar injuries
were most common. Associated injuries were common in
both groups.
Conclusion: Significant pancreatic injury can occur in the
absence of abnormality on medical imaging. Pancreatic
trauma commonly occurs in the context of multiple injuries
after motor vehicle accidents in children and bicycle handlebar
injuries, especially in boys. Most children can be
treated conservatively, with surgical intervention being
limited to high-grade ductal injury.