# Laparoscopic Distal Pancreatectomy for Pediatric Blunt Pancreatic Injury: A Case Series

## TL;DR

This case series explores the use of laparoscopic distal pancreatectomy in three pediatric patients with severe pancreatic injuries, highlighting surgical outcomes and decision-making challenges.

## Contribution

The paper presents a novel case series on laparoscopic management of grade III pancreatic injuries in children, emphasizing surgical timing and technique.

## Key findings

- Laparoscopic distal pancreatectomy was successfully performed in three pediatric patients with grade III pancreatic injuries.
- Early surgical intervention was necessary in two cases due to small patient size and failed non-surgical approaches.
- Delayed surgery in one case led to postoperative complications, underscoring the importance of timely decision-making.

## Abstract

Pancreatic injuries in pediatric patients are rare and present challenges in diagnosis and treatment due to patient size and limited evidence-based guidelines. This case series highlights the laparoscopic management, decision-making process, and outcomes of three pediatric patients with grade III pancreatic injuries.

Case 1 involved a two-year-old male with a near-complete transection of the pancreatic tail following a motor vehicle collision. He underwent laparoscopic distal pancreatectomy 24 hours post-injury, complicated by ileus and mild pancreatitis, which resolved without intervention. Case 2 was another two-year-old male with a complete pancreatic transection from blunt trauma, who underwent laparoscopic distal pancreatectomy 36 hours post-injury and was discharged uneventfully. Case 3 was a 12-year-old male with a mid-body pancreatic transection after a handlebar accident, who underwent delayed laparoscopic distal pancreatectomy seven days post-injury following failed pancreatic duct stenting. Postoperatively, he developed pancreatic leakage and bowel perforation, requiring additional surgeries, including a colostomy and further pancreatic resection.

Laparoscopy was selected in all cases due to hemodynamic stability and enhanced visualization of the pancreatic duct and splenic vessels. In Cases 1 and 2, small patient size precluded endoscopic retrograde cholangiopancreatography, prompting early surgical intervention. In Case 3, delayed surgery after failed stenting led to inflammation and significant postoperative complications. This series emphasizes the importance of timely surgical decision-making in pediatric pancreatic injuries. While laparoscopy offers advantages, challenges such as pancreatic duct identification and the risk of conversion to open surgery require careful intraoperative assessment.