WOFAPS 2025 8th World Congress of Pediatric Surgery

Hela Oueslati, Thamri Fatma, Yasmine Houas, Senda Houidi, Yosra Kerkeni, Sondes Sahli, Riadh Jouini, Said Jlidi

Department of Pediatric Surgery, Children’s Hospital, Faculty of medicine of Tunis, Tunis El Manar University, Tunis, Tunisia

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Introduction:

Pancreatic trauma in children is rare and often diagnostically elusive due to its subtle clinical presentation. Management strategies, particularly in the absence of associated injuries, continue to be debated.

Our aim was to highlight our outcomes from a non-operative approach in pediatric patients with isolated pancreatic injuries.

Methods:

We conducted a retrospective review of pediatric cases managed for pancreatic trauma in our department over a one-year period (June 2024 - June 2025).

Clinical presentation, diagnostic findings, treatment strategies, and early outcomes were analyzed.

Results:

Six children (4 males, 2 females; mean age 8.2 years) sustained blunt abdominal trauma :4 due to bicycle handlebar impacts and 2 from vehicular crush injuries. All of them presented with epigastric pain and vomiting within 24 hours post-trauma. Laboratory tests revealed marked lipase elevation (mean: 12× normal). Initial imaging with abdominal ultrasound and contrast-enhanced CT confirmed complete transections of the pancreas—body (n=3), tail (n=2), head (n=1) with an average parenchymal gap of 8.5 mm. No associated duodenal injuries were identified in any patient. Retroperitoneal fluid tracking to the mesenteric root and moderate intraperitoneal effusions were noted.

All patients were initially managed conservatively. Between days 5 and 8, five developed organized fluid collections (mean size: 120×70 mm), extending into the lesser sac and gastrosplenic area. Drainage was performed in five cases. It was either endoscopic transgastric (n=2) or radiologically guided percutaneous drainage (n=3). One child improved under close monitoring without drainage. All patients experienced progressive clinical and radiological resolution within approximately five weeks.

Conclusion:

In the absence of associated injuries, particularly duodenal involvement, non-operative management of pediatric pancreatic trauma, supported by timely, minimally invasive drainage, can lead to excellent short-term outcomes while avoiding the risks of surgery.