A Late Complication of Blunt Trauma in a Child: Hemorrhagic Pancreatic Pseudocyst

Öz

Trauma is the most important cause of morbidity and mortality in the pediatric population. Pancreatic injury is relatively rare but has high morbidity and mortality when the diagnosis is delayed. However, diagnosis of pancreatic trauma is difficult. Ultrasound is limited for diagnosing pancreatic injury. Magnetic resonance imaging (MRI) is very useful for detecting direct and secondary signs of pancreatic injury and its complications such as abscess, fistula, pancreatitis, and pseudocyst. We presented a 10-year-old boy with a hemorrhagic pancreatic pseudocyst due to blunt trauma that happened a week ago. His laboratory findings showed elevated serum amylase and lipase levels. In abdominal ultrasonography, bilobular thick-walled fluid collections in the pancreatic parenchyma and peripancreatic location were observed. MRI showed hemorrhagic pseudocysts in the pancreas and pancreatic duct injury. The pseudocysts were treated by cysto-gastrostomy. Children should be carefully evaluated for pancreatic injury and late complications such as hemorrhagic pancreatic pseudocyst to reduce mortality after blunt trauma.

Anahtar Kelimeler

• Magnetic Resonance
• Pancreatic pseudocyst
• Pancreatic trauma
• Ultrasound

Kaynakça

1. Aydogdu, B., Arslan, S., Zeytun, H., Arslan, M. S., Basuguy, E., İçer, M., … Cıgdem, M. K. (2016). Predicting pseudocyst formation following pancreatic trauma in pediatric patients. Pediatric Surgery International, 32(6), 559–563.
2. Bradley 3rd, E. L., Young Jr, P. R., Chang, M. C., Allen, J. E., Baker, C. C., Meredith, W., … Thomason, M. (1998). Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Annals of Surgery, 227(6), 861.
3. Debi, U., Kaur, R., Prasad, K. K., Sinha, S. K., Sinha, A., & Singh, K. (2013). Pancreatic trauma: a concise review. World Journal of Gastroenterology: WJG, 19(47), 9003.
4. Gupta, A., Stuhlfaut, J. W., Fleming, K. W., Lucey, B. C., & Soto, J. A. (2004). Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics, 24(5), 1381–1395.
5. Haider, F., Al Awadhi, M. A., Abrar, E., Al Dossari, M., Isa, H., Nasser, H., … Al Arayedh, S. (2017). Pancreatic injury in children: a case report and review of the literature. Journal of Medical Case Reports, 11(1), 1–5.
6. Igwe, P. O., Ray-Offor, E., Karibi, E. N., Okeke, U. F., Ugwa, O. C., & Jebbin, N. J. (2020). Giant pseudocyst of the pancreas: a report of three cases. International Journal of Surgery Case Reports, 77, 284–297.
7. Ilahi, O., Bochicchio, G. V, & Scalea, T. M. (2002). Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: a single-institutional study. The American Surgeon, 68(8), 704–708.
8. Jeffrey, R. B., Laing, F. C., & Wing, V. W. (1986). Ultrasound in acute pancreatic trauma. Gastrointestinal Radiology, 11, 44–46.

9. Jobst, M. A., Canty Sr, T. G., & Lynch, F. P. (1999). Management of pancreatic injury in pediatric blunt abdominal trauma. Journal of Pediatric Surgery, 34(5), 818–824.
10. Lenhart, D. K., & Balthazar, E. J. (2008). MDCT of acute mild (nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. American Journal of Roentgenology, 190(3), 643–649.
11. Linsenmaier, U., Wirth, S., Reiser, M., & Körner, M. (2008). Diagnosis and classification of pancreatic and duodenal injuries in emergency radiology. Radiographics, 28(6), 1591–1602.
12. Madiba, T. E., & Mokoena, T. R. (1995). Favourable prognosis after surgical drainage of gunshot, stab or blunt trauma of the pancreas. British Journal of Surgery, 82(9), 1236–1239.
13. Meredith, J. W., & Trunkey, D. D. (1988). CT scanning in acute abdominal injuries. The Surgical Clinics of North America, 68(2), 255–268.
14. Sutherland, I., Ledder, O., Crameri, J., Nydegger, A., Catto-Smith, A., Cain, T., & Oliver, M. (2010). Pancreatic trauma in children. Pediatric Surgery International, 26, 1201–1206.