What is a Pancreatic Injury?
The pancreas is not well protected in children due to their thin abdominal walls and underdeveloped muscles, so they are more likely than an adult to have a pancreas injury.
A pancreatic injury can happen after a car crash, fall, bike wreck, or any activity that causes a hard blow to the abdomen.
A penetrating pancreatic injury can be caused by a gunshot, knife, or other sharp object that cuts or tears the pancreas.
Function of the Pancreas
The pancreas is found behind the stomach and is divided into three parts: the head, body and tail.
The part of the pancreas lying over the spine is most likely to be injured.
The job of the pancreas is to aid digestion. The pancreas makes glucagon, insulin and digestive enzymes.
Diagnosis of a Pancreatic Injury
A child with a pancreatic injury will usually have belly pain. Nausea and vomiting are also common. After the trauma, the child may or may not have bruising on the abdomen.
If a pancreas injury is suspected, the trauma surgery providers will thoroughly and carefully examine your child. X-rays, a computed tomography (CT) scan, ultrasound or blood tests may be done to determine how badly your child's pancreas is damaged.
The American Association for the Surgery of Trauma (AAST) grades pancreas injuries 1-5. The grade is determined by the size and location of the injury in the pancreas seen on CT scan. Grade 1 is the least severe and 5 is the most severe.
Treatment for Pancreatic Injuries
Typically, children with grade 1 - 4 pancreatic injuries are admitted to the general care unit. Children with grade 5 pancreatic injuries may be admitted to the general care unit or to the intensive care unit (ICU). Fortunately, most pancreatic injuries are treated without surgery. Depending on the grade of injury, treatment can include strict bed rest, nothing to eat or drink for a short period of time, pain control, lab work, and IV fluid hydration. Blood transfusions can sometimes also be necessary.
If the pancreas is damaged severely, surgery may be necessary to try to repair it.
If your child has surgery, he / she will not be allowed to eat after surgery for some time. However, he / she will be given an IV (a small tube in their vein) for fluid hydration. He / she may also have a nasogastric tube (a tube placed through the nose into the stomach) after surgery to keep their stomach empty. Your child may be watched closely for any bleeding in the ICU for several days after surgery, then moved to the general care unit as healing continues.
Medications and Pain Management
Speak to your trauma surgery provider about medications your child was taking prior to their admission to the hospital and obtain approval to resume home medications. Your child may have some pain or soreness at home. Give Acetaminophen (also known as “Tylenol") for pain.
Your child's trauma surgery provider may also write a prescription for stronger pain medication. Give the stronger medication if the pain does not go away one hour after giving Acetaminophen. Follow the directions on the prescription
Do not give your child NSAIDs or Ibuprofen (also known as Motrin, Advil, Aleve, etc.) until the trauma surgery provider says that it is okay. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements..
Wound and Skin Care
Your child may shower or take a bath, but may need help for several days after going home. Check with your doctor about taking baths if your child has had surgery.
If you child has had surgery, check with your trauma surgery provider about taking a shower or bath. Follow instructions given by trauma surgery regarding any other injuries or wounds.
If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry.
Activity After a Pancreatic Injury
Your child does not need to stay in bed but should walk and play quietly while they heal. Your child should not play rough with family, friends, or pets. He / she should not participate in any contact activities or sports until instructed by the trauma surgery provider. The length of activity restrictions will depend on the grade of the pancreas injury.
Returning to Daycare or School
Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations regarding going back to school. If surgery was needed or your child has other injuries, they may be out of school longer. At school, your child should not be taking gym class until your trauma surgery says it's okay. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. Your child should not carry or lift more than one to two textbooks at a time, even if he / she carries a book bag or backpack.
When to Call Your Trauma Surgery Provider
Call the trauma clinic or seek medical attention if your child has:
- Increased or worsening abdominal pain
- Fever >100.5
- Difficulty with bowel movements
- Shortness of breath
- Nausea / vomiting
- Dizziness
- A fast heart rate
- Concern for wound infection (redness, swelling, pus drainage, or increased wound pain)
Emotional Recovery
After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read, or do small craft projects for short periods of time.
Infants and toddlers are harder to distract and will be more difficult to confine. Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit, but for short periods of time and not at the same time to minimize activity.
After any trauma children may experience acute stress symptoms that may be reflective of post-traumatic stress disorder (PTSD). If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms please speak with the trauma surgery provider. Short term therapy can be provided to help children heal and recover emotionally after a trauma.
Follow-up / Contact Us
Sometimes follow-up testing is needed. All children with pancreas injuries will be seen in the trauma clinic one or two weeks after discharge. An appointment will be made for you before you leave the hospital or you will be given a number to call to make an appointment. The trauma clinic number is 513-636-8556.
Once it is okay for your child to return to normal activity, no further follow-up will be needed. After your child has healed, he / she is not at an increased risk to hurt their pancreas again.
Preventive Actions
It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle. Children under 13 years old are safer in the back seat in the correct child restraint. For questions or to schedule a car seat safety check please call 513-803-7433.
Make sure your child wears the correct type of helmet when riding a bike, using other wheeled toys, or taking part in other active sports.
For more injury prevention tips and resources visit our Comprehensive Children’s Injury Center.
