A non-operative strategy for grade IV blunt pancreatic trauma

Pancreatic injuries are relatively uncommon in the pediatric population but when present, they can be a challenge to the surgeon in terms of diagnosis and management. When the injury involves the pancreatic duct it has a major impact on patient's outcome and, potentially, a higher morbidity. The management options are controversial. In the past, pancreatic duct injuries were often approached immediately with laparotomy and pancreatic dissection in an attempt to repair the pancreatic duct, sometimes compromising endocrine and exocrine function. Recently more attempts were made towards conservative management of pancreatic injuries. For paediatric patients there is compelling evidence that even when there is a pancreatic duct disruption it can be effectively managed in a conservative manner. We present a case of a 3-year-old child with a grade IV blunt pancreatic trauma with concomitant injuries to the liver and spleen that was successfully managed conservatively.