DOI: http://dx.doi.org/10.18203/2349-2902.isj20214777

Early pancreaticogastrostomy: a better and novel approach for high grade traumatic pancreatic injuries - case report from tertiary care centre in India

Shashwat Vyas, Pankaj Porwal

Abstract


Traumatic pancreatic injury is a rare entity which is associated with severe morbidity and mortality. The management varies according to the American association for the surgery of trauma-organ injury scale (AAST-OIS) grading of injury, hemodynamic status and time of definitive diagnosis. Non-operative versus operative management has potential risks and benefits and long term debate on the ideal management is still ongoing. A 19-year boy, with severe, generalised pain abdomen was admitted after road traffic accident. Upon admission, the investigations: ultrasonography (USG) and computed tomography (CT) scan abdomen, showed traumatic pancreatic injury (AAST-OIS, grade V), was taken for exploratory laparotomy which revealed lacerated head of pancreas along with normal distal segment of pancreas with no associated injury to nearby hollow viscera, vascular structures. He underwent primary closure of head of pancreas with distal segment pancreaticogastrostomy. Postoperatively he recovered well with no complications. In the present case, as he had traumatic pancreatic injury (AAST-OIS, grade V) and there was no involvement of hollow viscera and vascular structures, the operative intervention can decrease morbidity as by pancreaticogastrostomy we have diverted the pancreatic fluid into stomach, subsequently decreasing the chances of pseudocyst, fistula, necrosis of pancreas. Thus we conclude, high grade blunt traumatic abdomen injuries should be managed with adequate resection and subsequent reconstruction and/or drainage procedure. Pancreaticoduodenectomy, distal pancreatectomy, pancreaticogastrostomy, pancreaticojejunostomy are the available options to be used according to the grading of injury and associated injuries.


Keywords


Traumatic pancreatic injury, Pancreaticogastrostomy, Pancreatic reconstruction procedures, Blunt abdominal trauma

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References


Farrell RJ, Krige JEJ, Bornman PC, Knottenbelt JD, Terblanche J. Operative strategies in pancreatic trauma. Br J Surg. 1996;83(7):934-7.

Degiannis E, Glapa M, Loukogeorgakis SP, Smith MD. Management of pancreatic trauma. Injury. 2008;39(1):21-9.

Ayoob AR, Lee JT, Herr K, LeBedis CA, Jain A, Soto JA, et al. Pancreatic Trauma: Imaging Review and Management Update. RadioGraphics. 2021;41(1):58-74.

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.

El-badry A, Ali M. Surgical management of traumatic pancreatic injuries and their consequences. Int Surg J., 2020;7(11):3555-62.

Søreide K, Weiser TG, Parks RW. Clinical update on management of pancreatic trauma. HPB (Oxford). 2018;20(12):1099-108.

Ull C, Bensch S, Schildhauer TA, Swol J. Blunt Pancreatic Injury in Major Trauma: Decision-Making between Nonoperative and Operative Treatment. Case Rep Surg. 2018;6197261.

Menahem B, Guittet L, Mulliri A, Alves A, Lubrano J. Pancreaticogastrostomy Is Superior to Pancreaticojejunostomy for Prevention of Pancreatic Fistula After Pancreaticoduodenectomy. Ann Surg. 2015;261(5):882-7.

Jurkovich GJ. Pancreatic and duodenal injuries. In: Cassan A, editor. Volume 1. ACS Surgery Principles & Practice. 2013;21-35.