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Background: Pancreatic trauma in children is a serious condition with high morbidity. Blunt traumatic pancreatic lesions in children can be treated non-operatively or operatively. For less severe, grade I and II, blunt pancreatic trauma a non-operative or conservative approach is usually employed. Currently, the optimal treatment, of whether to perform operative or non-operative treatment of severe, grade III to V, blunt pancreatic injury in children is unclear., Objectives: To assess the benefits and harms of operative versus non-operative treatment of blunt pancreatic trauma in children., Search Methods: We searched the Cochrane Injuries Group's Specialised Register, Cochrane Central Register of Controlled Trials (Issue 5, 2013), MEDLINE (OvidSP), EMBASE (OvidSP), ISI Web of Science (SCI-EXPANDED and CPCI-S) and ZETOC. In addition, we searched bibliographies of relevant articles, conference proceeding abstracts and clinical trials registries. We conducted the search on the 21 June 2013., Selection Criteria: We planned to select all randomised clinical trials investigating non-operative versus operative treatment of blunt pancreatic trauma in children, irrespective of blinding, publication status or language of publication., Data Collection and Analysis: We used relevant search strategies to obtain the titles and abstracts of studies that were relevant for the review. Two review authors independently assessed trial eligibility., Main Results: The search found 83 relevant references. We excluded all of the references and found no randomised clinical trials investigating treatment of blunt pancreatic trauma in children., Authors' Conclusions: This review shows that strategies regarding non-operative versus operative treatment of severe blunt pancreatic trauma in children are not based on randomised clinical trials. We recommend that multi-centre trials evaluating non-operative versus operative treatment of paediatric pancreatic trauma are conducted to establish firm evidence in this field of medicine.

Pancreatic trauma is more frequent in children than in adults and is often caused by trauma to the upper part of the abdomen. Mortality is low, but morbidity is high. Pancreatic trauma can be treated operatively or non-operatively, but there is disagreement about the optimal treatment strategy for patients with severe pancreatic lesions. In general, good results are achieved with non-operative treatment and secondary surgery is avoided, but prospective trials are needed to evaluate the method.

Diagnosis and treatment of pancreatic trauma in children is challenging. Grade I and II lesions of the pancreas (Organ Injury Scale of the American Association of Trauma) are generally treated non-operatively. However, the optimal treatment of pancreatic lesions with involvement of the pancreatic duct (grade III-V) has still to be determined. In this report, we describe a child with a grade III traumatic lesion of the pancreas, who was successfully treated conservatively. Furthermore, we discuss diagnostic and treatment strategies of paediatric pancreatic injuries.

Background: Traditionally, severe pathology of the duodenum has been treated by a pancreaticoduodenectomy using Whipple's operation. Pancreas-preserving total duodenectomy (PPTD) was introduced in the late 1990s as an alternative to Whipple's operation for selected diseases of the duodenum. We report our 10 years' experience with this operation., Methods: In the period from 1999 to 2010 13 patients (mean age 50 years) underwent PPTD. Ten patients had duodenal adenomatosis (Spigelman stage IV). Two patients had large solitary tubulovillous adenomas, and one patient had multiple duodenal gastrointestinal stromal tumor lesions., Results: No mortality was observed. Six patients (46%) had a total of ten postoperative complications. Three patients (23%) had leakage of the ampullo-jejunostomy anastomosis, and one patient (8%) had leakage of the duodeno-jejunostomy anastomosis; all were treated conservatively with good results. One patient had recurrent episodes of pancreatitis, which disappeared spontaneously 3 months after operation. Three patients suffered from wound dehiscence, and two patients had postoperative pneumonia. Mean hospital admittance was 19 days (range 9-50 days). All patients were well at a mean follow-up of 56 months (range 2-134 months)., Conclusion: Pancreas-preserving total duodenectomy appears to be a safe and valuable treatment option for patients with selected diseases of the duodenum.

Pancreatic metastases from renal cell carcinoma (RCC) are rare. This study evaluated the surgical pathology and outcomes after resection of RCC metastases to the pancreas. A retrospective review of from 1 January 2011 to 31 December 2021, of patients who underwent pancreatic surgery for metastases from RCC. Data were retrieved from a prospectively managed database and patient demographics, comorbidities, pathology, perioperative outcomes, and overall survival were analyzed. Median overall survival (OS) and disease-free survival (DFS) were estimated by the Kaplan-Meier method. There were 25 patients (17 males, 8 females, median age 66 range 51 – 79 year), all with metachronous metastases. Median time from resection of the primary to operation for pancreatic RCC was 95.6 (12.0 − 309.7) months. Twenty-four patients were operated with intended cure (four pancreaticoduodenectomies, three total pancreatectomies, 17 distal pancreatectomies) and one patient had abortive surgery due to dissemination. Postoperative surgical complications occurred in nine patients (36%), and one patient died during hospital stay. Eight patients (33.3%) developed exocrine and/or endocrine insufficiency after pancreatic resection. Fifteen patients (60%) had recurrence 21.7 (4.9 − 61.6) months after pancreatic operation. Five patients (25%) died from RCC during follow-up 46.3 (25.6 − 134.8) months after pancreatic resection. Five-year OS and DFS were83.6% and 32.3%, respectively. Median OS after pancreatic surgery was 134.8 months, independent of resection of previous extrapancreatic metastases. Pancreatic resection for metastases from RCC offers favorable prognosis with a curative potential and should be considered a valuable treatment option even in the era of novel targeted treatment. [ABSTRACT FROM AUTHOR]

Pancreaticoduodenectomy is the preferred treatment of neoplasms in the pancreas and duodenum. Postoperative pancreatic fistula is a critical complication. A potential predictive marker is C-reactive protein. This retrospective study examined the predictive value of C-reactive protein as a marker for development of postoperative pancreatic fistulas. All patients who had a pancreaticoduodenectomy from 1 January 2015 to 31 December 2019, were included. Levels of the biomarker and linear trajectory were determined for postoperative days one to four. Univariate analysis was used to identify predictive variables for a postoperative pancreatic fistula. Receiver operating characteristics curves, specificity, and sensitivity were calculated. Five hundred and fifty-two patients underwent pancreaticoduodenectomy. C-reactive protein level greater than 121.5mg/L on the third postoperative day and an increase in C-reactive protein level between the first and fourth postoperative days, greater than 21.7mg/L, seemed to be reliable predictors. For Grade C postoperative pancreatic fistulas, increases in C-reactive protein, greater than 40.6ml/L the first four postoperative days, had a sensitivity of 100%. White blood cell count did not have similar reliability in predicting postoperative pancreatic fistulas. Our findings indicate that small rises in C-reactive protein during the first postoperative days after pancreaticoduodenectomy are associated with an increased risk of developing postoperative pancreatic fistula. [ABSTRACT FROM AUTHOR]

Background: Traditionally, severe pathology of the duodenum has been treated by a pancreaticoduodenectomy using Whipple's operation. Pancreas-preserving total duodenectomy (PPTD) was introduced in the late 1990s as an alternative to Whipple's operation for selected diseases of the duodenum. We report our 10 years' experience with this operation. Methods: In the period from 1999 to 2010 13 patients (mean age 50 years) underwent PPTD. Ten patients had duodenal adenomatosis (Spigelman stage IV). Two patients had large solitary tubulovillous adenomas, and one patient had multiple duodenal gastrointestinal stromal tumor lesions. Results: No mortality was observed. Six patients (46%) had a total of ten postoperative complications. Three patients (23%) had leakage of the ampullo-jejunostomy anastomosis, and one patient (8%) had leakage of the duodeno-jejunostomy anastomosis; all were treated conservatively with good results. One patient had recurrent episodes of pancreatitis, which disappeared spontaneously 3 months after operation. Three patients suffered from wound dehiscence, and two patients had postoperative pneumonia. Mean hospital admittance was 19 days (range 9-50 days). All patients were well at a mean follow-up of 56 months (range 2-134 months). Conclusion: Pancreas-preserving total duodenectomy appears to be a safe and valuable treatment option for patients with selected diseases of the duodenum. [ABSTRACT FROM AUTHOR]