Abstract
Introduction:
Pancreatic injury is a rare occurrence in pediatric trauma, with blunt pancreatic trauma reported in only 0.3% of cases. 1 Both operative and conservative management strategies have been described for management of complete pancreatic transection. 2 We present a video demonstrating a technique for performing a laparoscopic splenic-sparing distal pancreatectomy.
Patient and Method:
The patient is a 5-year-old boy who sustained a midpancreatic transection from an auto vs pedestrian trauma. He was noted on imaging to have a complete transection of his distal pancreas. The procedure was performed using a four 5-mm trocar technique: one placed at the umbilicus for the camera, one on each side of the umbilicus, just lateral to the midclavicular lines, and one at the left subcostal area. First the lesser sac was entered by dividing the gastrocolic ligament using electric cautery. Two 2.0 Prolene® transabdominal sutures were placed, anchoring the posterior aspect of the stomach to maximize exposure of the operative field. A splenic-sparing distal pancreatectomy was formed using mainly hook electric cautery. The duct was secured with an endo-GIA stapler.
Results:
The patient did well and was discharged home on postoperative day 9. Subsequently, he was readmitted with fevers and was found to have two fluid collections in the pancreatic bed concerning for an infected pseudocyst. He was started on antibiotics and underwent CT-guided percutaneous drain placement with a culture that grew S. aureus. His fevers resolved and he was discharged. He has been seen in clinic and is doing well.
Conclusion:
A laparoscopic approach is a safe and feasible management strategy in children with pancreatic transection.
No competing financial interests exist.
Runtime of video: 3 mins 23 secs
This video was presented at IPEG's 27th Annual Congress for Endosurgery in Children in Seattle, WA, April 2018.
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