Children (teenage) footballers who suffer an impact injury, such as with a knee to their abdomen during a football game should be closely examined for damage to their pancreas.
That is the recommendation of a study of pancreatic injuries in young Australian Rules footballers published in the latest issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine.
Mr. Paul R Burton, from the Upper GI Surgical Unit at the Alfred Hospital and Monash University Department of Surgery, and Mr. Edmund Fenton, Director of Paediatric Surgery and paediatric surgeon at Royal Hobart Hospital, described three cases of blunt pancreatic injury occurring during under-age AFL matches over a 12-month period.
“Blunt injury to the pancreas is rare in children. However, it has significant physiological effects and can result in death." “The most common injury mechanism is a high-velocity motor vehicle accident." “Bicycle accidents, non-accidental injuries, and falls can also cause pancreatic injury,” the researchers say.
Because the pancreas is in a relatively protected area of the body, it is not surprising that these injuries are uncommon. "AFL is a free-flowing game that combines certain attributes of soccer and rugby." “There is an emphasis on physical contact and high-velocity interpersonal collisions are frequent.”
All three of the teenagers (two aged 15 and one aged 16) in this study spent about a week in hospital. Two of them recovered well, but the third developed significant complications requiring major surgery five months after the original injury.
“Football players running at speed are vulnerable while concentrating on the ball, as they might be struck with considerable force by an opponent running at equal speed in the opposite direction."
“Also when players have both arms outstretched above their head when attempting to catch the ball, their abdomen is vulnerable to direct contact from the knee or torso of an opponent.”
The authors consider younger children are unlikely to be at risk of pancreatic injuries in sporting contests as the forces generated in collisions between smaller and less mature athletes are not sufficient to result in such injury.
However, they warn that it is possible similar injuries could occur in other contact sports played in Australia such as rugby where a high-energy impact can be made to the abdomen, such as by a forceful knee to a player lying on the ground.
Early diagnosis of blunt pancreatic injuries is difficult on clinical grounds alone, they say, particularly since symptoms might not be present for up to 48 hours. They urge parents and sporting coaches to be aware of the dangers associated with contact sports, ensuring mismatches in terms of sizes, ages and maturity of underage footballers does not occur. Appropriate medical advice should be sought in the event of significant collisions.
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