Experience in the treatment of isolated posttraumatic pancreatic injury complicated by the formation of pseudocysts in a 9-year-old child

Abstract

The number of cases of traumatic pancreatic damage in children has increased by 1%2% over the last several decades, which is related to an increase in car accidents and the popularity of outdoor sports (cycling and scooter). A 9-year-old boy was admitted to Childrens City Clinical Hospital after being injured in a bicycle fall. The boy complained of pain in the upper abdomen and around the wound on the anterior abdominal wall when he was admitted. The victim was conscious during the examination, the abdomen was not bloated, soft, or uncomfortable on probing in the higher portions, and peritoneal symptoms were negative. An ultrasound examination of the abdominal organs revealed symptoms of pancreatic injury, including the creation of a hematoma up to 58 mL in size. The general blood test found leukocytosis (12.75 109/L) and an increase in amylase up to 1,664 U/L. Following preoperative preparation, a diagnostic laparoscopy was conducted, which included opening and draining the omental sac, as well as cleanliness and drainage of the abdominal cavity. The patient was given antimicrobial, hemostatic, infusion therapy, pancreatic secretion inhibitors, and food nutrition following the procedure. During the dynamics of the ultrasound examination, a pseudocyst of the pancreas with a volume of up to 22 mL was noted. The situation improved with treatment, the amylase indices reduced (271 U/L), and the child was discharged home 44 days a day. After 4.5 months, the cyst increased to 320 mL; therefore, during planned hospitalization, a laparotomy was performed with the imposition of pancreatocystojejunoanastomosis on the Roux-enabled loop. The postoperative time was uneventful, and the child was released from the hospital on the 14th day. The diagnosis was confirmed through laparoscopy, and the omental sac and abdominal cavity were sterilized before drainage. Constant monitoring of the ultrasound image of the pancreatoduodenal zone and the dynamics of amylase markers allowed for the identification and evaluation of posttraumatic changes in the pancreas. An increase in the volume of the pseudocyst served as an indication for the imposition of pancreatocystojejunoanastomosis on the Roux-en-Y loop.