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We read with interest the paper by Graham, O’Tool et al about pancreatic trauma in Scottish children. We would echo most of the findings as they are in keeping with our own experience and other series.
We would, however, recommend a lower threshold for the use of ERCP than outlined in their publication. This is because the development of ERCP has been such that , in addition to providing valuable information regarding the status of the main pancreatic duct, ERCP may also provide valuable information about the presence of pancreatic pseudocysts and may form part of the therapeutic maneuver of the drainage of these pseudocysts.
We recently published our experience of endoscopic drainage of the pancreatic pseudocyst, which included a group of children whose pseudocyst was secondary to pancreatic trauma. We found that it was possible to successfully drain the psuedocyst definitely without recourse to laparotomy, thus, sparing these children the morbidity of an open procedure.
Since the publication of our initial report, we have treated more cases in the same way with further success.
As mentioned by the authors, prognosis of isolated pancreatic injury is good. It is our feeling that the use of minimal evasive therapies may help to avoid the apparently uncommon, but potentially debilitating, long-term sequelae of these injuries.
We would recommend, therefore, the use of ERCP in defining the ductal anatomy in children with documented pancreatic trauma, and the use of endoscopic drainage techniques in those cases of pancreatic pseudocysts in which the main pancreatic duct is seen to be intact.
PROFESSOR G. VITALE Department of Surgery, University of Louisville S. MACLEOD Specialist Registrar in Oral & Maxillofacial Surgery
1. Graham CA, O’Toole SJ, Watson AJM, Munro FD, Haddock G. Pangreatic trauma in Scottish children
J R Coll Surg Edinb 2000: 45:223-26
2. Hall RI, Lavelle MI, Venables CW. Use of ERCP
to identify the site of traumatic injuries to the main
pancreatic duct in children. BJS 1986:73 411-12
3. Vitale GC, Lawhon JC, Larson GM, Harrell DJ, Reed DN, MacLeod S. Endoscopic drainage of the
pancreatic pseudocyst. Surgery 1999: 126:616-623
Sir,
We thank Professor Vitale and Mr MacLeod for their interest in our article. We agree that ERCP is a useful technique for these patients and that endoscopic drainage techniques would minimise pseudocyst-associated morbidity.
We agree that ERCP should be actively considered in children who have sustained pancreatic trauma to evaluate the integrity of the pancreatic duct.
COLIN. A. GRAHAM Specialist Registrar in Accident & Emergency Medicine, Southern General Hospital, Glasgow