Pediatric emergency medicine trisk 3193 3193

FIGURE 103.7 Abdominal computed tomography (reformat) of a 12-year-old boy who crashed his bicycle, landing on the handlebar strut, showing a grade liver laceration measuring approximately 9.5 cm, and a moderate amount of free fluid indicative of hemoperitoneum Pancreatic Injuries Blunt abdominal injuries, particularly from bicycle handlebars, are the most common cause of pancreatic injury in children, although this injury is infrequent Diagnosis is often delayed because of the nonspecific nature of subjective complaints and physical examination findings Suspicion is raised when a classic “handlebar ecchymosis” is noted on the abdomen The classic triad of epigastric pain, a palpable abdominal mass, and hyperamylasemia is detected only rarely in children and may develop slowly The pancreas is relatively well protected and associated trauma such as hepatic and intestinal injuries is commonly present when injury to the pancreas has occurred Although peripancreatic fluid on CT imaging is suggestive of a pancreatic injury, determination of the integrity of the main pancreatic duct often requires additional imaging such as MRI In some