Pediatric emergency medicine trisk 3193 3193

FIGURE 103.7 Abdominal computed tomography (reformat) of a 12-year-old boy who crashed
his bicycle, landing on the handlebar strut, showing a grade 3 liver laceration measuring
approximately 9.5 cm, and a moderate amount of free fluid indicative of hemoperitoneum.

Pancreatic Injuries
Blunt abdominal injuries, particularly from bicycle handlebars, are the most
common cause of pancreatic injury in children, although this injury is infrequent.
Diagnosis is often delayed because of the nonspecific nature of subjective
complaints and physical examination findings. Suspicion is raised when a classic
“handlebar ecchymosis” is noted on the abdomen. The classic triad of epigastric
pain, a palpable abdominal mass, and hyperamylasemia is detected only rarely in
children and may develop slowly. The pancreas is relatively well protected and
associated trauma such as hepatic and intestinal injuries is commonly present
when injury to the pancreas has occurred. Although peripancreatic fluid on CT
imaging is suggestive of a pancreatic injury, determination of the integrity of the
main pancreatic duct often requires additional imaging such as MRI. In some