injuries has been developed by the AAST, which is important for discussing the
injuries as well as validating treatment strategies.^24 Also similar to spleen and
liver injuries, the vast majority of renal injuries are blunt in nature, and can be
managed non-operatively with several studies have documented renal
preservation in over 95% of children [25-27]. Unfortunately, no evidence-based
guidelines regarding length of activity restriction in these patients exist. A multi-
institutional prospective study allowing for immediate ambulation and discharge
based on standard criteria, rather than resolution of gross hematuria, is
currently underway to address possible guidelines. Indications for operative
intervention include hemodynamic instability, penetrating injuries, and, in some
centers, urinary extravasation and urinoma [26-28]. Selective
angioembolization of renal artery branches has been successful in nearly 80%
of cases with delayed hemorrhage [29].
C. Pancreatic Injury
Pediatric pancreatic injuries are rare, but occur more commonly than in
adults with a reported incidence of approximately 5%. The most common
mechanism of injury is blunt trauma, often a handlebar or seatbelt injury.
Patients usually present with epigastric pain and bilious emesis, particularly in
the case of injuries that have a delayed presentation. CT scan with IV contrast
is the preferred imaging study, although definitive identification ductal injuries
may require ERCP (endoscopic retrograde cholangiopancreaticogram).
Recently, magnetic retrograde cholangiopancreatography (MRCP) has been
shown to be useful.
marcin
(Marcin)
#1