Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children
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In brief
In brief
This multicenter study of 100 children with blunt pancreatic injuries found that 42% developed peripancreatic fluid collections or pseudocysts during non-operative management. Most collections resolved with observation alone, and early drainage did not improve outcomes compared to watchful waiting, though larger collections (≥7.1 cm) required longer recovery time.
Written by the GCMD Library team from the article.
Abstract
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