Pediatric emergency medicine trisk 3195 3195

FIGURE 103.8 Abdominal computed tomography of a 6-year-old boy who fell onto the
handlebar of his bicycle, showing a pancreatic hematoma and pseudocyst formation.

Nasogastric decompression and bowel rest are indicated when pancreatic injury
is suspected. Nonoperative therapy is normally used initially for children with
isolated pancreatic contusion caused by blunt trauma. Maturation of the
pseudocyst may necessitate surgical drainage, although spontaneous resolution
may occur in 25% of children. Experience with percutaneous drainage of
pancreatic pseudocysts in children is increasing, but the traditional approach has
been to use surgical internal drainage once a pseudocyst has persisted beyond 6
weeks. When severe pancreatic crush or transection is suspected, the surgeon may
elect to perform immediate exploration and resection or drainage.

Hollow Abdominal Viscera Injuries
Intestinal perforation caused by blunt abdominal trauma is rare in the pediatric
age group, but the most common causes of this injury are automobile–pedestrian
trauma, automobile lap belt injuries, and child abuse. The mechanisms of injury
usually involve rapid acceleration or deceleration of a structure near a point of
anatomic fixation (e.g., ligament of Treitz), or trapping of a piece of bowel
between two unyielding structures such as a lap belt and the spine. Hollow
visceral injury may be difficult to diagnose because physical findings may be
minimal and/or nonspecific for the first few hours, and abdominal CT is not
particularly sensitive in this situation. However, bowel contents, bile, and
activated pancreatic enzymes are extremely irritating to the peritoneum over time.