Management of pancreatic trauma in adult patients: a single centre experience
Keywords:Pancreatic trauma, NOM pancreatic trauma, Pancreatic injury, Conservative treatment, Radiologic drainage
Background: Pancreatic trauma is very rare and its management is complex. The aim of this study was to report our experience in the management of pancreatic trauma.
Methods: All patients who were admitted with pancreatic trauma from May 2017 to May 2019 were reviewed retrospectively. Demographic data and baseline characteristics were recorded. Grading of pancreatic trauma was carried out according to the American Association for surgery for Trauma (AAST). Data were represented by frequency and mean.
Results: A total of 24 patients were admitted with pancreatic trauma in the study period. Road traffic accident (n=17) was the leading cause followed by falls (n=5) and assault (n=2). Out of 24 patients, 3 patients had grade I pancreatic injury, 6 patients had grade II AAST injury, 9 patients had grade III injury and 6 patients had grade IV injury. No patients had grade V injury. Mean hospital stay was 12.3±4.2 days. One patient with grade 2 injury underwent surgery for liver laceration, all others were managed conservatively. Patients with grade 3 and 4 injuries were managed conservatively. One patient with grade 3 injury required, cystogastrostomy for pseudocyst 1 month after the index admission. Two patients of grade 4 injury underwent surgery, one patient for traumatic pseudocyst after 1 month and another patient for bleeding pseudoaneurysm of gastroduodenal artery 1 month after trauma. No patient underwent pancreatectomy. There was no mortality in the study population.
Conclusions: Pancreatic trauma can be managed conservatively irrespective of the grade of injury in haemodynamically stable patients.
Cogbill TH, Moore EE, Morris JJ, Hoyt DB, Jurkovich GJ, Mucha JP, et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma. 1991;31(12):1600-6.
Heuer M, Hussmann B, Lefering R, Taeger G, Kaiser GM, Paul A, et al. Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm. Langenbecks Arch Surg 2011;396:1067-76.
Jones RC. Management of pancreatic trauma. Am J Surg. 1985;150:698-704.
Krige JE, Kotze UK, Hameed M, Nicol AJ, Navsaria PH. Pancreatic injuries after blunt abdominal trauma: an analysis of 110 patients treated at a level 1 trauma centre. South Afjournal of Surg. 2011;49(2):58-67.
Schecter WP, Hirshberg A. Pancreatic and duodenal injuries. In: Jarnagin WR, editor. Blumgart’s surgery of the liver, biliary tract and pancreas 5th ed. Philadelphia, PA: Saunders, Elsevier; 2012: 1815-1821.
Cirillo RL, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg. 2002;6:587-98.
Kao LS, Bulger EM, Parks DL, Byrd GF, Jurkovich GJ. Predictors of morbidity after traumatic pancreatic injury. J Trauma. 2003;55:898-905.
Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm J. The importance of Advanced Trauma Life Support (ATLS) in the emergency room. Der Unfallchirurg. 2004;107(10):844-50.
Jurkovich GJ, Carrico CJ. Pancreatic trauma. Surg Clin North Am. 1990;70(3):575-93.
Bradley EL 3rd, Young PR Jr, Chang MC, Allen JE Baker CC, Meredith W, et al. Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review. Ann Surg. 1998;227:861-9.
Ilahi O, Bochicchio GV, Scalea TM, Aaland MO. Efficacy of computed tomography in the diagnosis of pancreatic injury in adult blunt trauma patients: A single-institutional study/Discussion. Am Surg. 2002;68(8):704-8.
Phelan HA, Velmahos GC, Jurkovich GJ, Friese RS, Minei JP, Menaker JA, et al. An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma Acute Care Surg. 2009;66(3):641-7.
Tyburski JG, Dente CJ, Wilson RF, Shanti C. Infectious complications following duodenal and/or pancreatic trauma/Discussion. Am Surg. 2001;67(3):227.
Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990;30(11):1427-9.
Pata G, Casella C, Di Betta E, Grazioli L, Salerni B. Extension of nonoperative management of blunt pancreatic trauma to include grade III injuries: a safety analysis. World J Surg. 2009;33(8):1611-7.
Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon JW, Malangoni MA. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg. 1997;63(7):598-604.
Vasquez JC, Coimbra R, Hoyt DB, Fortlage D. Management of penetrating pancreatic trauma: an 11-year experience of a level-1 trauma center. Injury. 2001;32(10):753-9.
Patton JH, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, et al. Pancreatic trauma: a simplified management guideline. J Trauma Acute Care Surg. 1997;43(2):234-41.
Smego DR, Richardson JD, Flint LM. Determinants of outcome in pancreatic trauma. J Trauma 1985;25:771-6.
Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg. 1990;125:1109-13.
Sharpe JP, Magnotti LJ, Weinberg JA, Zarzaur BL, Stickley SM, Scott SE, et al. Impact of a defined management algorithm on outcome after traumatic pancreatic injury. J Trauma Acute Care Surg. 2012;72(1):100-5.
Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg. 1991;78:1196-202.
Björnsson B, Kullman E, Gasslander T, Sandström P. Early endoscopic treatment of blunt traumatic pancreatic injury. Scandinavian J Gastroenterol. 2015;50(12):1435-43.
Feliciano DV, Martin TD, Cruse PA, Graham JM, Burch JM, Mattox KL, et al. Management of combined pancreatoduodenal injuries. Ann surg. 1987;205(6):673.
Mansour MA, Moore JB, Moore EE, Moore FA. Conservative management of combined pancreatoduodenal injuries. Am J Surg. 1989;158(6):531-5.
Strobel O, Schneider L, Philipp S, Fritz S, Büchler MW, Hackert T. Emergency pancreatic surgery—demanding and dangerous. Langenbeck's Arch Surg. 2015;400(7):837-41.
Degiannis E, Boffard K. Duodenal injuries. Br J Surg. 2000;87:1473-9.
Menahem B, Lim C, Lahat E, Salloum C, Osseis M, Lacaze L, et al. Conservative and surgical management of pancreatic trauma in adult patients. Hepato Surg Nutr. 2016;5(6):470-7.