One early and three delayed distal pancreatectomies without splenectomy and with preservation of the splenic vessels after traumatic transection of the distal pancreas in children

Four children are presented with Class II pancreas injury as a result of a motor vehicle accident. The first child was taken to the operating room promptly due to concomitant perforation of the hollow viscus (gastric rupture) and underwent successful spleen-sparing distal pancreatectomy with preservation of the splenic artery and vein. The next three cases with isolated abdominal symptoms of pancreatic injury generally experienced a delay of one day before the onset of abdominal symptoms and positive diagnostic investigation results and were managed non-operatively (NOM) on admission ; they were then treated surgically due to developing peritonitis after 24, 36, and 38 hours, respectively. The same type of operation, even though delayed and technically much more demanding, was performed, but this was not an obstacle to our efforts to preserve the spleen and its full circulation, in order to provide full immunological and haematological support during the expected prolonged postoperative course. We did not lose any of the children. A reintervention was needed in two children due to the retention of necrotic tissue and intraabdominal abscess. The serum amylase level in all cases remained above normal. We believe that a spleen-preserving distal pancreatectomy with splenic vessel conservation can be safely performed, even in delayed operations, and should be indicated for the surgical management.