A rare case of blunt trauma abdomen leading to isolated grade 4 pancreatic injury
DOI:
https://doi.org/10.18203/2349-2902.isj20211329Keywords:
Blunt trauma abdomen, Isolated grade 4 pancreatic injury, PancreaticojejunostomyAbstract
Isolated pancreatic injury due to blunt trauma abdomen is a rare case in children and is associated with higher morbidity and mortality rates. We present a case of isolated grade 4 pancreatic injury in a 12 years old male child, presented with history of trauma to abdomen by bicycle handle, pain in abdomen, abdominal distention and vomiting. Ultrasonography of revealed hemoperitoneum with peri-pancreatic fluid collection, Contrast enhanced Computed tomography of abdomen and pelvis showed grade 4 pancreatic injury with mild hemoperitoneum. Emergency exploratory laparotomy was done and saponified part of pancreas along with omentum was debrided and Roux-en-Y pancreaticojejunostomy was performed. Procedure was uneventful and patient recovered well in post-operative period. In conclusion, isolated grade 4 pancreatic injury is a rare presentation following blunt trauma to abdomen and conservative approach as well as many operative procedures have been described for treatment of such injury. Roux-en-Y pancreaticojejunostomy procedure can be considered as a definitive treatment in such cases and to avoid long term complications.
References
Antonsen I, Berle V, Søreide K. Blunt pancreatic injury in children. Tidsskr Nor Laegeforen. 2017;137(17).
Townsend CM, Beauchamp DR, Evers BM, Mattox KL. Sabiston textbook of surgery South Asia edition 4. Elsevier India. 2016; 440-441.
Williams SM, O’Connel PR, McCasksie A. Bailey and Love’s Short practice of surgery. 27 Ed. India: CRC Press. 2018: 375.
Ahmed N, Vernick JJ. Pancreatic injury. South Med J. 2009;102(12):1253-6.
Lane MJ, Mindelzun RE, Jeffrey RB. Diagnosis of pancreatic injury after blunt abdominal trauma. Semin Ultrasound CT MR. 1996;17(2):177-82.
Linker CS, DeLuca SA. Traumatic pancreatic transection. Am Fam Physician. 1989; 40(6):127-8.
Gupta A, Stuhlfaut JW, Fleming KW, Lucey BC, Soto JA. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Radiographics. 2004;24(5):1381-95.
Dondelinger RF, Boverie JH, Cornet O. Diagnosis of pancreatic injury: a need to improve performance. JBR-BTR. 2000; 83(4):160-6.
Canty TG Sr, Weinman D. Management of major pancreatic duct injuries in children. J Trauma. 2001;50(6):1001-7.
Jobst MA, Canty TG Sr, Lynch FP. Management of pancreatic injury in pediatric blunt abdominal trauma. J Pediatr Surg. 1999;34(5):818-23.
Keil R, Drabek J, Lochmannova J, Stovicek J, Rygl M, Snajdauf J, et al. What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children? Scand J Gastroenterol. 2016;51(2):218-24.
Lin BC, Wong YC, Chen RJ, Liu NJ, Wu CH, Hwang TL, Hsu YP. Major pancreatic duct continuity is the crucial determinant in the management of blunt pancreatic injury: a pancreatographic classification. Surg Endosc. 201731(10):4201-10.
Jahromi AH, D'Agostino HR, Zibari GB, Chu QD, Clark C, Shokouh-Amiri H. Surgical versus nonsurgical management of traumatic major pancreatic duct transection: institutional experience and review of the literature. Pancreas. 2013;42(1):76-87.
Wood JH, Partrick DA, Bruny JL, Sauaia A, Moulton SL. Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg. 2010; 45(2):401-6.
Potoka DA, Gaines BA, Leppäniemi A, Peitzman AB. Management of blunt pancreatic trauma: what's new? Eur J Trauma Emerg Surg. 2015; 41(3):239-50.
Haulik L, Tóth B, Issekutz A, Gartner B. Tompa hasi trauma okozta pancreas transsectio a korai, illetve késói diagnózis és sebészi ellátás tükrében Pancreatic injury in blunt abdominal trauma: early versus late diagnosis and surgical management. Magy Seb. 2001;54(5):309-13.
Lin BC, Chen RJ, Hwang TL. Lessons learned from isolated blunt major pancreatic injury: Surgical experience in one trauma centre. Injury. 2019;50(9):1522-8.
Torba M, Gjata A, Rulli F, Kajo I, Ceka S, Asqeri T. Delayed diagnosis and treatment of high grade blunt pancreatic trauma. Case report and review of literature. Ann Ital Chir. 2017;88:539-45.
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.
Iqbal CW, Peter SD, Tsao K, Cullinane DC, Gourlay DM, Ponsky TA, et al. Pancreatic Trauma in Children (PATCH) Study Group. Operative vs nonoperative management for blunt pancreatic transection in children: multi-institutional outcomes. J Am Coll Surg. 2014;218(2):157-62.