A case with missed pancreatic injury with massive pancreatic ascites and severe traumatic pancreatic necrosis: a case report and literature review
DOI:
https://doi.org/10.18203/2349-2902.isj20183740Keywords:
Blunt pancreatic injury, Pancreatic ascites, Pancreatic necrosisAbstract
Despite the major advances in the field of trauma management. High grade Blunt pancreatic injury remains a disease with both high mortality and morbidity specially in cases of delayed diagnosis. Herein we will present a case report of 31 years old Saudi male who was involved in motor vehicle accident with a delayed diagnosis of pancreatic injury associated with other multiple injuries. He was diagnosed late on 12th day of admission during laparotomy where a missed high-grade pancreatic fracture at the neck of pancreas, massive pancreatic ascites and extensive pancreatic necrosis was found. Open abdominal closure technique with mesh mediated fascial closure and Vacuum assisted closure was used to improve both respiratory function and abdominal disease through repeated debridement with peritoneal lavage and sequential approximation of fascia. He responded well gradually and offered definitive closure of fascia and feeding jejunostomy. Unfortunately, he had a sudden stroke followed by rapid deterioration then expired 48 hours later.
References
Krige JEJ, Bornman PC, Beningfield SJ, Funnell IC. Pancreatic trauma. In: Pitt H, Carr-Locke D, Ferrucci J, eds. Hepatobiliary and Pancreatic Disease. Philadelphia: Little, Brown and Co.; 1995.
Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon JW, Malangoni MA. Pancreatic trauma: a 10 year multi-institutional experience. Am Surg. 1997;63:598-604.
Krige JEJ. Pancreatic trauma. In: Nicol AJ, Steyn E, eds. Handbook of Trauma. Cape Town: Oxford University Press; 2004:258-265.
Farrell RJ, Krige JEJ, Bornman PC, Knottenbelt JD, Terblanche J. Operative strategies in pancreatic trauma. Br J Surg. 1996;83:934-7.
Frey CF, Wardell JW. Injuries to the pancreas. In: Trede M, Carter DC, eds. Surgery of the Pancreas. Edinburgh: Churchill Livingstone; 1993: 565-589.
Smego DR, Richardson JD, Flint LM. Determinants of outcome in pancreatic trauma. J Trauma. 1985;25:771-6.
Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg. 1991;78:1196-202.
Patton JH Jr, Fabian TC. Complex pancreatic injuries. Surg Clin North Am. 1996;76:783-95.
Timberlake GA. Blunt pancreatic trauma: experience at a rural referral center. Am Surg. 1997;63:282-6.
Asensio JA, Petrone P, Roldán G, Pak-Art R, Salim A. Pancreatic and duodenal injuries. Complex and lethal. Scand J Surg. 2002;91:81-6.
Stone HH, Fabian TC, Satiani B, Turkleson ML. Experiences in the management of pancreatic trauma. J Trauma. 1981;21:257-62.
Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg. 1990;125:1109-13.
Thomas H, Madanur M, Bartlett A, Marangoni G, Heaton N, Rela M. Pancreatic trauma-12-year experience from a tertiary center. Pancreas. 2009;38:113-6.
Takishima T, Sugimoto K, Hirata M, Asari Y, Ohwada T, Kakita A. Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations. Ann Surg. 1997;226:70-6.
Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg. 1990;125:1109-13.
Cirillo RL, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg. 2002;6:587-98.
Bradley EL, young PR, Chang MC, Allen JE, Baker CC, Meredith W, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multi-institutional review. Ann Surg. 1998;227:861-9.
Venkatesh SK, Wan JM. CT of blunt pancreatic trauma: a pictorial essay. Eur J Radiol. 2008;67:311-20.
Wong Yc, Wang LJ, Lin BC, Chen CJ, Lim KE, Chen RJ. CT grading of blunt pancreatic injuries: prediction of ductal disruption and surgical correlation. J Comput Assist Tomogr. 1997;21:246-50.
Wright MJ, Stanski C. Blunt pancreatic trauma: a difficult injury. South Med J. 2000;93:383-5.
Moore EE, Cogbill TH, Malangoni MH, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling. II. Pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30:1427-9.
Jurkovich GJ, Carrico CJ. Pancreatic trauma. Surg Clin North Am. 1990;70:575-93.
Patton JH Jr, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, et al. Pancreatic trauma: a simplified management guideline. J Trauma. 1997;43:234-41.
Amirata E, Livingston DH, Elcavage J. Octreotide acetate decreases pancreatic complications after pancreatic trauma. Am J Surg. 1994;168:345-7.
Boffard KD, Brooks AJ. Pancreatic trauma—injuries to the pancreas and pancreatic duct. Eur J Surg. 2000;166:4-12.
Broe PJ, Cameron JL. Pancreatic ascites and pancreatic pleural effusion in Bradley EL III (Ed), Complications of pancreatitis medical and surgical management. WB Saunders, Philadelphia Co; 1982:245-264.
Cabrera J. Ascitis De pancreatic origin. Med clin Barc. 1986;86;369-72.
Gomez- Cerezo J, Barbado Cano A, Suarez I, Soto A. Pancreatic ascites: study of therapeutic options by analysis of case reports and case series between the years 1975s and 2000. Am J Gastroenterol. 2003;98(3):568-77.
Cameron JL, Anderson RD, Zuidema G. Pancreatic ascites. Surg Gynecol Obstet. 1967;125:328.
Cameron JL. Chronic pancreatic ascites and pancreatic pleural effusion. Gastroenterol. 1978;74:134-40.
Parekh D, Segal I. Pancreatic ascites and effusion. Risk factors for failure of conservative therapy and the role of octreotide. Arch Surg. 1992;127:707-12.
