TY - JOUR
T1 - Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children
AU - Rosenfeld, Eric H.
AU - Vogel, Adam M.
AU - Jafri, Mubeen
AU - Burd, Randall
AU - Russell, Robert
AU - Beaudin, Marianne
AU - Sandler, Alexis
AU - Thakkar, Rajan
AU - Falcone, Richard A.
AU - Wills, Hale
AU - Upperman, Jeffrey
AU - Burke, Rita V.
AU - Escobar, Mauricio A.
AU - Klinkner, Denise B.
AU - Gaines, Barbara A.
AU - Gosain, Ankush
AU - Campbell, Brendan T.
AU - Mooney, David
AU - Stallion, Anthony
AU - Fenton, Stephon J.
AU - Prince, Jose M.
AU - Juang, David
AU - Kreykes, Nathaniel
AU - Naik-Mathuria, Bindi J.
N1 - Publisher Copyright:
© 2019, Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2019/8/8
Y1 - 2019/8/8
N2 - Background: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. Methods: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called “acute peripancreatic fluid collection” (APFC) if identified < 4 weeks and “pseudocyst” if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal–Wallis and t tests. Results: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1–16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7–42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75). Conclusions: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. Level of evidence: III Study type: Case series.
AB - Background: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. Methods: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called “acute peripancreatic fluid collection” (APFC) if identified < 4 weeks and “pseudocyst” if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal–Wallis and t tests. Results: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1–16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7–42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75). Conclusions: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. Level of evidence: III Study type: Case series.
KW - Pediatric pseudocysts
KW - Pseudocysts
KW - Trauma
KW - pancreatic trauma
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U2 - 10.1007/s00383-019-04492-3
DO - 10.1007/s00383-019-04492-3
M3 - Article
C2 - 31161252
AN - SCOPUS:85066865879
SN - 0179-0358
VL - 35
SP - 861
EP - 867
JO - Pediatric Surgery International
JF - Pediatric Surgery International
IS - 8
ER -