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Pediatr Surg Int. 2019 Aug;35(8):861-867. doi: 10.1007/s00383-019-04492-3. Epub 2019 Jun 3.

Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children.

Author information

1
Department of Surgery, Baylor College of Medicine, 6701 Fannin Street # 1210, Houston, TX, 77030, USA.
2
Department of Surgery, Saint Louis University Children's Hospital, St. Louis, MO, USA.
3
Department of Surgery, Randall Children's Hospital at Legacy Emmanuel, Portland, OR, USA.
4
Doernbecher Children's Hospital Oregon Health and Science University, Portland, OR, USA.
5
Department of Surgery, Children's National Medical Center, Washington, DC, USA.
6
Department of Surgery, Children's of Alabama, Birmingham, AL, UK.
7
Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada.
8
Division of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH, USA.
9
Department of Surgery, Cincinnati Children's Hospital, Cincinnati, OH, USA.
10
Department of Surgery, Hasbro Children's Hospital, Providence, RI, USA.
11
Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA.
12
Department of Surgery, MultiCare Mary Bridge Children's Hospital and Health Center, Tacoma, WA, USA.
13
Department of Surgery, Mayo Clinic, Rochester, MN, USA.
14
Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA.
15
Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN, USA.
16
Department of Pediatric Surgery, Connecticut Children's Medical Center, Hartford, CT, USA.
17
Department of Surgery, Boston Children's, Boston, MA, USA.
18
Department of Surgery, Carolinas HealthCare System, Charlotte, NC, USA.
19
Department of Surgery, University of Utah, Salt Lake City, UT, USA.
20
Department of Surgery, Cohen's Children's Hospital, Aurora, CO, USA.
21
Department of Surgery, Children's Mercy Hospital, Kansas City, MO, USA.
22
Children's Hospital of Minnesota, Minnesota, MN, USA.
23
Department of Surgery, Baylor College of Medicine, 6701 Fannin Street # 1210, Houston, TX, 77030, USA. bnaik@texaschildrens.org.

Abstract

BACKGROUND:

Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes.

METHODS:

A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called "acute peripancreatic fluid collection" (APFC) if identified < 4 weeks and "pseudocyst" if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal-Wallis and t tests.

RESULTS:

One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1-16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7-42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75).

CONCLUSIONS:

Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery.

LEVEL OF EVIDENCE:

III STUDY TYPE: Case series.

KEYWORDS:

Pediatric pseudocysts; Pseudocysts; Trauma; pancreatic trauma

PMID:
31161252
DOI:
10.1007/s00383-019-04492-3

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