ECMO-/ECLS

Regarding specific injuries, isolated contusions can be managed non-
operatively with gut rest until the abdominal pain has resolved. An oral diet can
then be re-introduced while monitoring for signs of pancreatitis. Trends in
serum amylase and lipase may be helpful, although the absolute value of these
tests does not correlate with outcome [30].^ When a ductal injury is
encountered, surgical intervention is generally required. Management of ductal
transection is currently controversial. The standard approach for a distal ductal
transaction is a laparoscopic or open spleen preserving distal pancreatectomy
[31-32]. Although this procedure is well tolerated, concerns regarding late
morbidity, particularly endocrine insufficiency, have led to other treatment
approaches including Roux-en-Y distal pancreaticojejunostomy using a
retrocolic jejunal limb to drain the distal pancreas, while some have advocated
a non-operative approach to pancreatic ductal injuries, with percutaneous or
endoscopic drainage of subsequent pseudocysts [33-35]. A recent APSA
Trauma Committee retrospective review compared operative and non-operative
management for blunt pancreatic injury. Although they found a similar length of
hospitalization, a higher rate of pseudocyst formation and days on total
parenteral nutritional (TPN) was seen in the nonoperative group [36].
Additionally, patients who underwent non-operative management often requires
ERCP to define the ductal anatomy, perform sphincterotomy, and potentially
stent the pancreatic duct, as well as percutaneous or endoscopic drainage of
pseudocysts. A multiinstitutional review was conducted involving patients with
blunt pancreatic transection in twelve pediatric trauma centers reviewed non-