Successful management of a posttraumatic pancreatic fistula with somatostatin analog in a young child

The use of somatostatin to manage a persistent posttraumatic pancreatic fistula in a young child has not been previously reported. A 3-year-old, 20-kg female who sustained blunt trauma to the abdomen causing mesenteric, duodenal, and pancreatic injuries developed a posttraumatic pancreatic pseudocyst treated with external drainage. An external pancreatic fistula developed that was refractory to management with bowel rest and hyperalimentation. Synthetic somatostatin analog was administered subcutaneously over 11 days with a progressive decrease in fistula output. After 4 days the fistula output ceased and ultrasound examination documented that there were no undrained fluid collections. At 3-month follow-up she has remained completely asymtomatic, tolerating a regular diet without recurrence of the pseudocyst, and her serum amylase, liver function studies, and blood sugar values are normal. This case report demonstrates that external pancreatic fistulas in children can be successfully treated non-operatively with somatostatin analog.