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Laparoscopic splenic-preserving distal pancreatectomy for trauma in a child

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Abstract

Purpose

To reduce the risks associated with splenectomy, there has been a trend toward splenic preservation when performing distal pancreatectomy. Although laparoscopy has gained almost universal acceptance, it is still not utilized often for pancreatic surgery in children. In fact, review of the literature shows only a few case series of splenic-preserving laparoscopic distal pancreatectomy, and even less reported experience in the pediatric population [13]. To our knowledge, there has been only one other report of laparoscopic spleen-preserving distal pancreatectomy in the setting of trauma in a child [4].

Methods

A 13-year-old boy suffered a handlebar injury to the abdomen secondary to a dirt bike accident. He did not report loss of consciousness but complained of abdominal pain. CT scan revealed a grade II splenic laceration with a transected distal pancreas. He was hemodynamically stable with a large contusion in the left upper quadrant. Laboratory evaluation showed that his hematocrit was stable but was significant for elevated amylase and lipase. During his hospitalization, he developed significant abdominal distension and his amylase and lipase continued to rise. He was taken to the operating room for definitive management of his pancreatic injury 72 hours after his initial injury.

Results

In the operating room, a central line was placed so that he could receive total parenteral nutrition postoperatively. The video demonstrates the performance of a laparoscopic spleen-preserving distal pancreatectomy. There was a fair amount of old blood seen in the left upper quadrant and behind the pancreas. There was no evidence of active bleeding. The operation was performed without complication and with preservation of the splenic vessels.

Conclusions

The postoperative course was very smooth with the child resuming diet by postoperative day (POD) 4. He was sent home on POD 7. This video demonstrates that in the proper trauma patient, a minimally invasive approach to a spleen-preserving distal pancreatectomy can still be performed.

References

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    Sasaki A, Nitta H, Nakajima J, Obuchi T, Baba S, Wakabayashi G (2008) Laparoscopic spleen-preserving distal pancreatectomy with conservation of the splenic artery and vein: report of three cases. Surg Today 38:955–958

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    Bruzoni M, Sasson AR (2008) Open and laparoscopic spleen-preserving, splenic vessel-preserving distal pancreatectomy: indications and outcomes. J Gastrointest Surg 12:1202–1206

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    Melotti G, Cavallini A, Butturini G, Piccoli M, Delvecchio A, Salvi C, Pederzoli (2007) Laparoscopic distal pancreatectomy in children: case report and review of the literature. Ann Surg Oncol 14:1065–1069

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    Reynolds EM, Curnow AJ (2003) Laparoscopic distal pancreatectomy for traumatic pancreatic transection. J Pediatr Surg 38:E7–E9

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Disclosures

Drs. Marcus M. Malek, Sohail R. Shah, and Timothy D. Kane have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Timothy D. Kane.

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Supplementary material 1 (MPG 65185 kb)

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Malek, M.M., Shah, S.R. & Kane, T.D. Laparoscopic splenic-preserving distal pancreatectomy for trauma in a child. Surg Endosc 24, 2623 (2010) doi:10.1007/s00464-010-0961-x

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Keywords

  • Pediatric laparoscopy
  • Pancreas
  • Trauma