Abstract

Aim: The management of pancreatic pseudocysts which occur after blunt abdominal trauma in children is still controversial. In this study, we present our cases with pancreatic pseudocysts that occur after trauma, and discuss the therapeutic approach.

Material and Method: We evaluated 9 patients with traumatic pancreatic pseudocysts who were admitted in our clinic between 2003 and 2007. We performed ultrasonography, computerized tomography (CT) and blood amylase levels for all patients.

Result: There were 8 males, 1 female. Average age was 9.2 years (range, 6-15 years). The mechanism of injury was bicycle handle bar injury in 4, falls in 3, assault in 1 and motor vehicle accident in 1 patient. Abdominal pain was the most common symptom in all patients. The median size of cysts was 10.3 cm (range, 5-17 cm). The mean time between trauma and pancreatic pseudocysts was 17 days (range, 9-30 days). Ameng all patients, 4 (44.4 %) of them had taken place shorter than 2 weeks. Blood amylase levels were high in all patients. All patients were initially followed up conservatively. Conservative treatment consisted of nasogastric tube placement, total parenteral nutrition and antibiotics. Three patients (33 %) were successfully treated conservatively, while 6 patients (66 %) required intervention either by percutaneous radiological drainage (4), by cystogastrostomy (1) or by external drainage with laparotomy (1). One patient who was treated by percutaneous drainage developed septic shock and he was treated successfully. Another patient had persistent hyperamylasemia (8 months), although he had no symptoms. None of the patients died.

Conclusion: Traumatic pancreatic pseudocysts may occurri in a short time period after traumatic injury in children. All patients who have traumatic pancreatic pseudocysts should be managed by conservative approach initially. However, if the cyst is a cause of gastric outlet obstruction or the size of cyst is bigger than 6 cm, interventional management may be required.