Pancreatic trauma in children is rare; therefore, both scientific knowledge and clinical experience regarding its management are limited. Abdominal sonography and subsequent computed tomography (CT) imaging are the diagnostic mainstay after severe abdominal trauma in many pediatric trauma centers. However, the diagnosis of pancreatic injury is missed on the initial imaging in approximately one third of cases, with even higher numbers in young children. While conservative treatment is preferred in low-grade injuries, surgical interventions may be indicated in more severe injuries. We present a case series including four patients with high-grade pancreatic injury. Two patients were treated surgically with open laparotomy and primary suture of the head of the pancreas and pancreatico-enterostomy, one patient underwent endoscopic stenting of the pancreatic duct and one received conservative management including observation and secondary endoscopic treatment. We want to emphasize the fact that using a minimally invasive approach can be a feasible option in high-grade pancreatic injury in selected cases. Therefore, we advocate the necessity of fully staffed and equipped high-level pediatric trauma centers.

Background: Adriamycin, a chemotherapy drug, was first shown to induce malformations in rat embryos in 1978, with subsequent studies focusing on the development of esophageal atresia. Recently, we examined early tracheal development in healthy rat embryos using microcomputed tomography, which is useful for visualizing the morphology during embryonic development. Here, we use this technique to show malformations in rat embryos after Adriamycin treatment in the form of an atlas. Methods: Pregnant rats received Adriamycin [1.75 mg/kg body weight] intraperitoneally once daily from day 7 to 9. The embryos were harvested between the 16th and 21st embryonic day, fixed in Bouin’s solution and subsequently dried in a critical point dryer. The dried embryos were scanned using microcomputed tomography. Existing datasets of normal embryos served as controls. Results: The embryos affected by Adriamycin showed a broad spectrum of malformations that have only partially been described in previous publications. Our preliminary data show a large number of malformations that can be attributed to the VACTERL association (Vertebral, Anorectal, Cardiac, Tracheoesophageal, Renal, and Limb anomalies). In addition, cardiovascular malformations have been observed that may directly affect the esophageal/tracheal morphology. Conclusion: Micro CT imaging used in Adriamycin-affected embryos shows the full spectrum of induced malformations.