E. H. Rosenfeld1, A. M. Vogel12, M. Jafri14, R. Burd16, R. Russell6, M. Beaudin20, R. Thakkar11, R. A. Falcone Jr.18, H. Wills8, J. Upperman13, R. V. Burke13, M. Escobar3, D. B. Klinkner2, B. Gaines4, A. Gosain5, B. Campbell7, D. Mooney15, A. Stallion9, S. Fenton17, J. M. Prince19, D. Juang10, B. J. Naik-Mathuria1 1Baylor College Of Medicine,Department Of Surgery,Houston, TX, USA 2Mayo Clinic,Department Of Surgery,Rochester, MN, USA 3MultiCare Mary Bridge Children’s Hospital & Health Center,Department Of Surgery,Tacoma, WA, USA 4Children’s Hospital Of Pittsburgh Of UPMC,Pittsburgh, PA, USA 5Le Bonheur Children’s Hospital,Department Of Surgery,Memphis, TN, USA 6Children’s Of Alabama,Department Of Surgery,Biringham, AL, USA 7Connecticut Children’s Medical Center,Department Of Pediatric Surgery,Hartford, CT, USA 8Hasbro Children’s Hospital,Department Of Surgery,Providence, RI, USA 9Carolinas HealthCare System,Department Of Surgery,Charlotte, NC, USA 10Children’s Mercy Hospital,Department Of Surgery,Kansas City, MO, USA 11Nationwide Children’s Hospital,Division Of Pediatric Surgery,Columbus, OH, USA 12Saint Louis University Childrens Hospital,Department Of Surgery,St. Louis, MO, USA 13Children’s Hospital Los Angeles,Department Of Surgery,Los Angeles, CA, USA 14Randall Childrens Hospital At Legacy Emmanuel,Department Of Surgery,Portland, OR, USA 15Boston Childrens,Department Of Surgery,Boston, MA, USA 16Children’s National Medical Center,Department Of Surgery,Washington, DC, USA 17University Of Utah,Department Of Surgery,Salt Lake City, UT, USA 18Cincinnati Children’s Hospital Medical Center,Department Of Surgery,Cincinnati, OH, USA 19Cohen’s Children Medical Center,Department Of Surgery,Aurora, CO, USA 20Centre Hospitalier Universitaire Sainte-Justine,Department Of Surgery,Montreal, QC, Canada 21Children’s Mercy Hospital- University Of Missouri Kansas City,Department Of Surgery,Kansas City, MO, USA 22Doernbecher Children’s Hospital Oregon Health And Science University,Department Of Surgery,Portland, OREGON, USA
Introduction: Traumatic pseudocysts often develop following non-operative management (NOM) of high-grade pancreatic injuries, but their management and impact is unclear. Our purpose was to review current practices and outcomes across a large cohort.
Methods: Multicenter, retrospective review of children treated with NOM following pancreatic injury (grades II-V) at 21 trauma centers between 2010-15. A persistent, peripancreatic fluid collection persisting more than 1 week after injury was considered a pseudocyst. Data analysis included descriptive statistics and Wilcoxon rank, Kruskal-Wallis χ2 and t-tests.
Results: Pseudocysts developed in 38/91 (42%) patients (range 0-4/center). Median time to identification was 11 days (IQR 7-19), median initial diameter was 7cm (range 2.2-33). Upon identification, 68% (25/38) were initially observed and 34% (13/38) had an intervention: percutaneous drain 10 (83%), percutaneous aspiration 1 (8%), pancreatic stent 2 (17%). Median pseudocyst diameter was similar among groups (observation: 5.6cm vs early intervention: 8cm, p=0.06). A definitive procedure (operation or endoscopic cyst-gastrostomy) for persistent symptoms was required in 29%.
Patients who developed pseudocysts had significantly longer hospital length of stay (LOS) (8 vs 23.5, p<0.01) and time to regular diet (5 vs 11, p<0.01) than those who did not. Patients with larger pseudocysts (>7cm) had similar hospital LOS (median days 25.5 vs 15, p=0.10) and time to regular diet (median days 41.5 vs 11, p=0.14) than those with smaller. Comparison of outcomes following pseudocyst observation vs early intervention revealed no differences in parenteral nutrition use (76% vs 75%, p=1), hospital LOS (16.5 vs 25 median days, p=0.32), time to regular diet (11 vs 12 median days, p=0.90), or requirement of definitive procedure (27% vs 25%, p=0.87).
Conclusions: Traumatic pseudocysts commonly develop following NOM of pancreatic trauma, and prolong recovery. Management is variable, and early intervention does not appear to improve outcomes. Larger studies are needed for validation.