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Wed Aug 27 21:20:23 BST 2008

Hello Gregory,

I have a different opinion from Norman and Juan.

If he continues to do well clinically...

I would NOT operate! (although I admit I love doing so...)

I would NOT hit him with more radiation. (Although it would be nice to see
the resolution of the pathology with the SAME imaging modality - more
"Academic"). 

We should treat the patient and not the CT scan...

Mind you, this is a BIG kid for a 13 year old - 188cm & 82 Kg, however he is
still a kid.  US follow-up will probably be good enough to detect the
possible long term complications (pseudocyst etc).

I admit my personal series of this type of ISOLATED blunt pancreatic trauma
that present with MILD symptoms is not long, I have seen 5-6 cases in 25
years.  3 in kids and 2 or three in adults.  One of the kids (11 y/o male)
with a handlebar bicycle injury, was transferred from a Level III TC after
developing SEVERE abdominal pain 18 hours after injury.  Since the "Crack"
of his pancreas was flush with the CBD at the head of the pancreas, we
elected to perform a Roux Y Pancreatico-Jejunostomy to the distal part of
the pancreas (otherwise we would have resected some 90% of his pancreas).
We (and he) were lucky and it worked fine.  He was discharged home on day 9.
The others all had an uneventful (to my knowledge) recovery with
conservative treatment.  Even the two that had endoscopic pancreatic duct
visualization, that showed a small amount of dye extravasation, resolved
with no untoward sequela.  I believe that those that have a major pancreatic
duct disruption WILL NOT DO WELL and will earn their laparotomy quite early
during their initial hospitalization course.

My 2.5 cents...

Mickey

*******************************************************************

Michael Stein MD

Chairman, Israel Trauma Society

Director of Trauma, Attending Surgeon

Department of Surgery,

Rabin Medical Center - Beilinson Hospital,

Petach-Tikva, 49100

ISRAEL

******************************************************************

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of Tidewater001
Sent: Wednesday, August 27, 2008 8:20 PM
To: trauma-list at trauma.org
Subject: Pancreatic fracture

Anyone out there have any thoughts on pancreatic trauma....case...13 y/o
male...6' 3" 180 lbs playing around with friends & got hit with someones
knee in upper abd. 36 hrs later comes to my facility with complaints of MILD
and pain...ER MD gets abd/pelvis CT and this shows fx of Pancreas at
head/body junction....small assoc.hematoma...no free fluid....labs all
normal...clinically he is fine...MRCP poor quality...GI will NOT
ERCP...repeat CT 48 hrs after admission shows improvement...diet advanced
without problems...I was planning repeat CT in 6-8 weeks to see how it
looks. Would anyone have done anything different...thanks

Gregory T. Squires, MD FACS

Clinical Assist. Prof. of Surgery

Medical University of SC

Director of Trauma

Trident Regional Medical Center

Charleston, SC 

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