Pancreatic blunt trauma in children: report from the Belgian Pancreatic Trauma Group

I. SCHEERS (1), G. ROEYEN (2), F. BERREVOET (3), I. HOFFMAN (4), A. LHOMME (5), O. BAURAIND (6), M. DELHAYE (7), P. DEPREZ (8) / [1] Cliniques universitaires Saint-Luc, Woluwe-Saint-Lambert, Belgium, Pediatric gastroenterology, hepatology and nutrition, [2] Antwerp University Hospital, Edegem, Belgium, Hepatobiliary, Endocrine, and Transplantation Surgery, [3] Ghent University Hospital, Ghent, Belgium, General Hepatobiliary Surgery and Liver Transplantation, [4] UZ Leuven, Leuven, Belgium, Pediatric Gastroenterology and Nutrition, [5] CHR La Citadelle, , Belgium, Pediatric Gastroenterology, [6] Hopital CHC Liège, , Belgium, Pediatric Gastroenterology, [7] Erasme Hospital, Brussels, Belgium, Gastroenterology, Hepatopancreatology and Digestive Oncology, [8] Cliniques universitaires Saint-Luc, Brussels, Belgium, Gastroenterology and Hepatology Introduction Pancreatic trauma is the fourth most frequent cause of abdominal trauma in children. Few studies focused on the impact of trauma severity and therapeutic management (surgery vs endoscopy vs observation) on mid- and long-term outcomes. Aim The aim of this study was to determine the mid and long-term outcome of children with grade III-V pancreas trauma and correlate this data with the initial patient management. Methods The charts of 47 children aged <18 years admitted in one of the 7 participating Belgian tertiary Hospitals between 01/2010 and 01/2020 for an abdominal trauma involving the pancreas were retrospectively reviewed. Data about trauma characteristics, clinical symptoms, imaging, therapeutic management and short to long-term complications were recorded. Results We identified 25 patients (11/22, 50% boys) aged 2-17 years (median: 9,2y; IQR 7-12,4). Fourteen patients had a grade III trauma following AAST, 10 had a grade IV and 1 a grade V. In 8/25 (32%) patients, pancreas trauma was associated to another organ lesion. Clinical symptoms are nonspecific to diagnose pancreatic involvement: pain (23/24, 96%) and nausea/vomiting (18/24, 75%). All children had increased amylase/lipase at admission. Four children were initially managed by endoscopy (1/14 grade III, 3/10 grade IV), 10 (4/14 grade III, 5/10 grade IV and 1/1 grade V injuries) patients had surgical management, while the other 11 children were managed conservatively. Median hospital stay was 17.5 days (IQR 13.5-25) and was neither influenced by trauma grade or by initial management. Mediate complications of pancreatic trauma consisted of pseudocysts; these were exclusively seen in patients managed conservatively (n=6 grade III and n=3 IV traumas) and were the main cause for rehospitalisation. Exocrine pancreatic function was followed (median follow-up: 0.8 years, IQR 0.2-5.5) in 8/14 and 8/10 patients respectively with grade III and IV traumas. Exocrine function tests were partially impaired in 3/24 (13%); all of them complained of intermittent symptoms of abdominal pain and steatorrhea. Instead, endocrine function (median duration of follow-up 2.9 years, IQR 0.4-7.4) was preserved in all of them. Conclusions This Belgian multicentric study showed that compared to grade I-II pancreatic traumas, children admitted for pancreatic blunt injury grade III-V were mainly managed surgically. Children managed conservatively had a higher risk of rehospitalisation for pseudocysts drainage, and were more likely to evolve to exocrine pancreatic dysfunction over time. Follow-up of patients with grade III-IV-V pancreatic trauma is important to detect those mid and long-term complications.