Title: Isolated Pediatric Pancreatic Transection Secondary to Ocean-Related Trauma | Insight Medical Publishing
Headings: Isolated Pediatric Pancreatic Transection Secondary to Ocean-Related Trauma
Isolated Pediatric Pancreatic Transection Secondary to Ocean-Related Trauma
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Abstract
Keywords
INTRODUCTION
CASE REPORT
DISCUSSION
Acknowledgments
Conflict of interest
Financial support
References

Content: CT scan is commonly employed in assessing abdominal injury in pediatric trauma [ 2 ]. CT scan has a reported sensitivity and specificity of 80% in the detection of pancreatic injury, with recognized limitations especially to disclose ductal injury, particularly in the first twelve hours, as soft tissue changes require time to evolve [ 2, 5, 7 ]. Within this time frame, the full extent of injury may not be evident, and this is especially true in the setting of transection, which may not be demonstrated until edema or fluid development allows for sufficient parenchymal disruption and separation of transected edges [ 2, 4, 5 ]. One study found that the initial CT scan missed one third of pancreatic injuries that were documented subsequently at surgery or with follow-up imaging [ 8 ]. The paucity of retroperitoneal fat in children was thought to have a negative impact [ 8 ]. The presence of lesser sac hematoma, pre-pancreatic edema, obscured pancreatic duodenal interface, and non-visualization of the extra-pancreatic vessels should increase suspicion of pancreatic injury [ 5 ]. Repeat CT scans 24 hours after injury have been advocated when clinical suspicion persists and definitive diagnosis remains elusive [ 4, 7 ]. Endoscopic retrograde cholangiopancreatography can be used for further delineation of duct injury if unclear with CT [ 9, 10 ]. The benefit of serum markers such as amylase and lipase to aid in evaluation or management of pancreatic injury has been controversial. Elevated serum amylase and lipase are common with pancreatic injuries but not pathognomonic, nor is the degree of elevation of these enzymes necessarily indicative of the extent of injury [ 4 ].