Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children

Eric H. Rosenfeld, Adam M. Vogel, Mubeen Jafri, Randall Burd, Robert Russell, Marianne Beaudin, Alexis Sandler, Rajan Thakkar, Richard A. Falcone, Hale Wills, Jeffrey Upperman, Rita V. Burke, Mauricio A. Escobar, Denise B. Klinkner, Barbara A. Gaines, Ankush Gosain, Brendan T. Campbell, David Mooney, Anthony Stallion, Stephon J. Fenton & 4 others Jose M. Prince, David Juang, Nathaniel Kreykes, Bindi J. Naik-Mathuria

Research output: Contribution to journalArticle

Abstract

Background: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. Methods: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called “acute peripancreatic fluid collection” (APFC) if identified < 4 weeks and “pseudocyst” if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal–Wallis and t tests. Results: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1–16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7–42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75). Conclusions: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. Level of evidence: III Study type: Case series.

Original languageEnglish (US)
JournalPediatric Surgery International
DOIs
StatePublished - Jan 1 2019

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Nonpenetrating Wounds
Drainage
Wounds and Injuries
Length of Stay
Pancreatectomy
Trauma Centers
Needles
Stents
Observation
Pediatrics
Diet

Keywords

  • pancreatic trauma
  • Pediatric pseudocysts
  • Pseudocysts
  • Trauma

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children. / Rosenfeld, Eric H.; Vogel, Adam M.; Jafri, Mubeen; Burd, Randall; Russell, Robert; Beaudin, Marianne; Sandler, Alexis; Thakkar, Rajan; Falcone, Richard A.; Wills, Hale; Upperman, Jeffrey; Burke, Rita V.; Escobar, Mauricio A.; Klinkner, Denise B.; Gaines, Barbara A.; Gosain, Ankush; Campbell, Brendan T.; Mooney, David; Stallion, Anthony; Fenton, Stephon J.; Prince, Jose M.; Juang, David; Kreykes, Nathaniel; Naik-Mathuria, Bindi J.

In: Pediatric Surgery International, 01.01.2019.

Research output: Contribution to journalArticle

Rosenfeld, EH, Vogel, AM, Jafri, M, Burd, R, Russell, R, Beaudin, M, Sandler, A, Thakkar, R, Falcone, RA, Wills, H, Upperman, J, Burke, RV, Escobar, MA, Klinkner, DB, Gaines, BA, Gosain, A, Campbell, BT, Mooney, D, Stallion, A, Fenton, SJ, Prince, JM, Juang, D, Kreykes, N & Naik-Mathuria, BJ 2019, 'Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children', Pediatric Surgery International. https://doi.org/10.1007/s00383-019-04492-3
Rosenfeld, Eric H. ; Vogel, Adam M. ; Jafri, Mubeen ; Burd, Randall ; Russell, Robert ; Beaudin, Marianne ; Sandler, Alexis ; Thakkar, Rajan ; Falcone, Richard A. ; Wills, Hale ; Upperman, Jeffrey ; Burke, Rita V. ; Escobar, Mauricio A. ; Klinkner, Denise B. ; Gaines, Barbara A. ; Gosain, Ankush ; Campbell, Brendan T. ; Mooney, David ; Stallion, Anthony ; Fenton, Stephon J. ; Prince, Jose M. ; Juang, David ; Kreykes, Nathaniel ; Naik-Mathuria, Bindi J. / Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children. In: Pediatric Surgery International. 2019.
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abstract = "Background: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. Methods: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called “acute peripancreatic fluid collection” (APFC) if identified < 4 weeks and “pseudocyst” if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal–Wallis and t tests. Results: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1–16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64{\%} (27/42) and pseudocysts 36{\%} (15/42). Median time to identification was 12 days (range 7–42). Most collections (64{\%}, 27/42) were observed and 36{\%} (15/42) underwent drainage: 67{\%} (10/15) percutaneous drain, 7{\%} (1/15) needle aspiration, and 27{\%} (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26{\%} (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79{\%} vs 75{\%}, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30{\%} vs 20{\%}, p = 0.75). Conclusions: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. Level of evidence: III Study type: Case series.",
keywords = "pancreatic trauma, Pediatric pseudocysts, Pseudocysts, Trauma",
author = "Rosenfeld, {Eric H.} and Vogel, {Adam M.} and Mubeen Jafri and Randall Burd and Robert Russell and Marianne Beaudin and Alexis Sandler and Rajan Thakkar and Falcone, {Richard A.} and Hale Wills and Jeffrey Upperman and Burke, {Rita V.} and Escobar, {Mauricio A.} and Klinkner, {Denise B.} and Gaines, {Barbara A.} and Ankush Gosain and Campbell, {Brendan T.} and David Mooney and Anthony Stallion and Fenton, {Stephon J.} and Prince, {Jose M.} and David Juang and Nathaniel Kreykes and Naik-Mathuria, {Bindi J.}",
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T1 - Management and outcomes of peripancreatic fluid collections and pseudocysts following non-operative management of pancreatic injuries in children

AU - Rosenfeld, Eric H.

AU - Vogel, Adam M.

AU - Jafri, Mubeen

AU - Burd, Randall

AU - Russell, Robert

AU - Beaudin, Marianne

AU - Sandler, Alexis

AU - Thakkar, Rajan

AU - Falcone, Richard A.

AU - Wills, Hale

AU - Upperman, Jeffrey

AU - Burke, Rita V.

AU - Escobar, Mauricio A.

AU - Klinkner, Denise B.

AU - Gaines, Barbara A.

AU - Gosain, Ankush

AU - Campbell, Brendan T.

AU - Mooney, David

AU - Stallion, Anthony

AU - Fenton, Stephon J.

AU - Prince, Jose M.

AU - Juang, David

AU - Kreykes, Nathaniel

AU - Naik-Mathuria, Bindi J.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. Methods: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called “acute peripancreatic fluid collection” (APFC) if identified < 4 weeks and “pseudocyst” if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal–Wallis and t tests. Results: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1–16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7–42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75). Conclusions: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. Level of evidence: III Study type: Case series.

AB - Background: Peripancreatic fluid collection and pseudocyst development is a common sequela following non-operative management (NOM) of pancreatic injuries in children. Our purpose was to review management strategies and assess outcomes. Methods: A multicenter, retrospective review was conducted of children treated with NOM following blunt pancreatic injury at 22 pediatric trauma centers between the years 2010 and 2015. Organized fluid collections were called “acute peripancreatic fluid collection” (APFC) if identified < 4 weeks and “pseudocyst” if > 4 weeks following injury. Data analysis included descriptive statistics Wilcoxon rank-sum, Kruskal–Wallis and t tests. Results: One hundred patients with blunt pancreatic injury were identified. Median age was 8.5 years (range 1–16). Forty-two percent of patients (42/100) developed organized fluid collections: APFC 64% (27/42) and pseudocysts 36% (15/42). Median time to identification was 12 days (range 7–42). Most collections (64%, 27/42) were observed and 36% (15/42) underwent drainage: 67% (10/15) percutaneous drain, 7% (1/15) needle aspiration, and 27% (4/15) endoscopic transpapillary stent. A definitive procedure (cystogastrostomy/pancreatectomy) was required in 26% (11/42). Patients with larger collections (≥ 7.1 cm) had longer time to resolution. Comparison of outcomes in patients with observation vs drainage revealed no significant differences in TPN use (79% vs 75%, p = 1.00), hospital length of stay (15 vs 25 median days, p = 0.11), time to tolerate regular diet (12 vs 11 median days, p = 0.47), or need for definitive procedure (failure rate 30% vs 20%, p = 0.75). Conclusions: Following NOM of blunt pancreatic injuries in children, organized fluid collections commonly develop. If discovered early, most can be observed successfully, and drainage does not appear to improve clinical outcomes. Larger size predicts prolonged recovery. Level of evidence: III Study type: Case series.

KW - pancreatic trauma

KW - Pediatric pseudocysts

KW - Pseudocysts

KW - Trauma

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