Pancreatic Laceration in a Pediatric Patient: An Unexpected Diagnosis.
Pancreatic Laceration in a Pediatric Patient: An Unexpected Diagnosis.
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DOI：
10.1155/2017/2681835
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发表时间：
2017
影响因子：
0.9
通讯作者：
Greenberg MR
中科院分区：
文献类型：
--
作者：
Hong MJ;Porter LM;Esernio-Jenssen DD;Miller AC;Greenberg MR
小儿胰腺损伤是罕见的。我们提出一个非典型的情况下，发生在一个4岁的男性。在急诊科检查时，患儿表现为24小时呕吐史，并发展为右下腹腹痛。最初的区别是胃肠炎和阑尾炎。超声异常和脂肪酶水平升高最终导致MRI显示胰腺后缘完全横断。患者被送进儿科外科，并接受了成功的远端胰腺切除术，保留了脾脏。在进一步询问有关创伤的问题时，这名儿童透露，他的哥哥在前一天晚上打了他的腹部。孩子的父母因亲密伴侣暴力而分居，这个哥哥最近压力很大。该兄弟姐妹被转介进行心理健康评估和咨询，并将案件报告给县儿童和青少年调查服务系统。当诊断出明显的腹内损伤时，建议在儿科人群中考虑创伤和儿童虐待的低阈值。
Pediatric pancreatic injuries are rare. We present an atypical case that occurred in a 4-year-old male. The child presented with a twenty-four-hour history of vomiting that had progressed to right lower quadrant abdominal pain on examination in the emergency department. The initial differential was gastroenteritis versus appendicitis. An abnormality on the ultrasonography and an elevated lipase level eventually led to an MRI showing a complete transection through the posterior margin of the pancreas. The patient was admitted to pediatric surgery and underwent a successful distal pancreatectomy with preservation of the spleen. On further inquiry specific to trauma, the child disclosed that his older brother had punched him in his abdomen the night before. The child's parents were separated due to intimate partner violence, and this older sibling recently had been very stressed. The sibling was referred for mental health evaluation and counseling, and the case reported to the county children and youth investigative services system. A low threshold for considering trauma and child abuse in the pediatric population is recommended when significant intra-abdominal injury is diagnosed.