Abstract
BackgroundPancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries.Case presentationA 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications.ConclusionsRoux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.
Highlights
Blunt abdominal injury causing significant and major pancreatic injury is rare in adolescents and young adults, with a controversial approach to its management
Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury
The position of the pancreas in the retroperitoneal region makes isolated injury a rare entity and resembles a challenge for the surgeon. It is graded into five grades ranging from minor contusion or small laceration without duct injury to major pancreatic duct or head disruption and transection according to the Association for the Surgery of Trauma organ injury scale (AAST-OIS)
Summary
Blunt abdominal injury causing significant and major pancreatic injury is rare in adolescents and young adults, with a controversial approach to its management. Case presentation A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object His pain was dull-aching in nature, localized to the epigastrium and left hypochondrial areas, aggravated and increased by movement and partially relieved by analgesia, but he had no fever, radiation, nausea, vomiting, or other associated symptoms. An exploratory laparotomy through upper midline incision revealed a normal spleen with a clear, thick fluid collection in the lesser sac and contused pancreas with peripancreatic hematoma and anterosuperior distal pancreatic body laceration with major duct injury of (1 × 1.2 cm punched-out pancreatic parenchymal tissue) approximately, involving pancreatic parenchyma and duct with preservation of the posterior duct wall and communication with the lesser sac collection and intact posterior parenchyma and pancreatic magna and splenic arteries confirming the diagnosis of grade III injury American Association for the Surgery of Trauma organ injury scale (AAST-OIS) intraoperatively. A follow-up for 6 months continued by phone, and it was uneventful; he went back to his work as a shepherd after 3 months and gained significant weight
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