Abstract
This case report illustrates the difficulty in diagnosing paediatric patients with life threatening pancreatic injuries. A high index of suspicion is essential as late diagnosis significantly affects outcomes. A 9-year-old child presented with epigastric pain following an accident on his pushbike. The patient was examined in paediatric accident and emergency (A/E) and was discharged. He returned twice more to A/E and on the third visit, 5 days after the initial incident, a CT scan was performed. This showed a classical injury to the body of the pancreas with a collection in the lesser sac. The patient was transferred to the regional hepato-pancreato-biliary unit (HPB unit) and underwent surgery. Pancreatic injuries can be difficult to detect clinically and patients may be well on initial presentation with normal observations and routine bloods. Early CT scanning confirms the diagnosis and results in early specialist referral and better outcomes.
Highlights
Blunt abdominal injury in paediatric patients is the primary mechanism for pancreatic injury
This paper highlights the importance of having a high index of suspicion for pancreatic injury in blunt abdominal trauma to the abdomen
Blunt abdominal trauma is a common cause for paediatric admissions to A/E
Summary
Blunt abdominal injury in paediatric patients is the primary mechanism for pancreatic injury. These injuries can lead to serious morbidity. The pancreas is a retroperitoneal structure and can be injured in blunt trauma to the epigastrium. These patients may initially present with minimal clinical signs. At initial presentation abdominal examination may be unremarkable due to the retroperitoneal nature of the pancreas. CT scan remains the gold standard for imaging the pancreas and other abdominal viscera. This paper highlights the importance of having a high index of suspicion for pancreatic injury in blunt abdominal trauma to the abdomen
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