41. Vỡ rời eo tụy do chấn thương bụng ở trẻ em: Thông báo ca bệnh tại Bệnh viện Bạch Mai và tổng quan y văn

Abstract

Pancreatic trauma without injuries to other organs is a rare disease. The treatment depends on the systemic condition, the co-morbidity, and the integrity of the pancreatic ducts. We reported a 14-year-old man who fell in abdominal pain after hitting the handle of the ladder with his upper abdominal quadrant. The patient was admitted to our hospital 10 hours 34 minutes after the blunt trauma with stable hemodynamics and epigastric wall hematoma. The computer tomography evidence of complete rupture of the pancreatic isthmus was 32x38mm. Blood test results showed red blood cells 4.8 T/L, white blood cells 15.4 G/L, prothrombin 90.2%, amylase 130 U/L, glucose 7.02 mmol/L, GOT 41 U/L, GPT 22 U/L. The patient underwent emergency surgery with intra-operative evidence of initial necrotic-hemorrhagic pancreatitis and pancreas was ruptured grade IV (AAST). The lesion was repaired with a Roux-en-y end-to-side pancreato-jejunal anastomosis. After 4 days of surgery, the patient ate again, stayed in the hospital for 12 days, and was discharged without complications. Conclusion: the best treatment must always be individualized. Preservation due to good pancreatic parenchyma should apply to most cases, especially in children. Pancreatic duct integrity and delays in diagnosis are determinants of treatment, complications, and mortality.