Pancreas-Specific Physical Examination Enabling Early Diagnosis of Pancreatic Injury in Children: A Case Report

TL;DR

This case report describes the use of Ihara's maneuver to detect a pancreatic injury in a child early, leading to timely treatment.

Contribution

The report highlights the effectiveness of Ihara's maneuver in diagnosing pediatric pancreatic injuries.

Findings

Ihara’s maneuver identified rebound tenderness in a child with a pancreatic injury.

Contrast-enhanced CT confirmed a distal pancreatic injury with fluid retention.

The patient required partial pancreatic resection and recovered after 57 days.

Abstract

Pediatric pancreatic injuries are rare but require early diagnosis. Ihara’s maneuver, a pancreas-specific palpation technique, is useful for the early diagnosis of pediatric pancreatic injuries. We herein report a case of pancreatic injury detected by Ihara’s maneuver. An early adolescent male patient presented with abdominal pain and vomiting following an abdominal contusion. His vital signs were normal. Ihara’s maneuver induced slight rebound tenderness in the left hypochondrium. Laboratory tests demonstrated elevated serum amylase and lipase. Contrast-enhanced computed tomography revealed a distal pancreatic injury with slight fluid retention. Magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography were required owing to worsening abdominal pain. A distal pancreatic transection with pancreatic ductal injury was diagnosed, and a partial pancreatic resection was performed. The patient was discharged 57 days after hospitalization. Ihara's maneuver, an anatomically specific palpation technique, is useful for the early detection of pancreatic injuries in pediatric patients.

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