Pancreaticoduodenal injuries at a tertiary care centre-clinical profile, associated injuries, management modalities, and outcomes
DOI:
https://doi.org/10.18203/2349-2902.isj20231732Keywords:
AAST injury grades, Duodenal injuries, Non operative management, Pancreatic injuriesAbstract
Background: Pancreaticoduodenal injuries are considerably associated with high morbidity and mortality due to delayed diagnosis and subsequent delay in treatment. This makes the treatment of these injuries challenging. We have studied the presentation, diagnosis, management and outcome of these complex injuries.
Methods: A prospective observational study was done at general surgery department, Government medical college Nagpur from October 2020 to September 2022. Mortality, morbidity, and various treatment modalities were evaluated.
Results: Thirty two patients presented to the Trauma care center with history and symptoms suggestive of isolated pancreatic, duodenal, and combined pancreaticoduodenal injuries. Most of the injuries were blunt trauma cases. The ratio of hemodynamically stable: unstable was 1:1. Majority injuries were to pancreas followed by duodenum and combined organ injuries. Most of cases were diagnosed by CT scan. In this study 56% of cases had a non-operative line of treatment while 44% underwent surgical intervention. Among the patients operated 5 died, within 7 days of admission due to post-operative complications-hemorrhage, sepsis, aspiration pneumonia, and anastomotic leak. Two patients died due to delayed complications due to the development of pancreatic fistula and enterocutaneous fistula. Mortality rate was 27.2% in this study.
Conclusions: Early presentation and prompt diagnosis is the key to the management of such injuries. Patients managed conservatively need close monitoring, repeated assessments, and long-term follow-up.
Metrics
References
Krige JE, Kotze UK, Setshedi M, Nicol AJ, Navsaria PH. Surgical management and outcomes of combined pancreaticoduodenal injuries: analysis of 75 consecutive cases. J Am Coll Surg. 2016;222(5):737-49.
Jones RC. Management of pancreatic trauma. Am J Surg. 1985;150:698-704.
Patton JH, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, et al. Pancreatic trauma: a simplified management guideline. J Trau Acute Care Surg. 1997;43(2):234-41.
Sims EH, Mandal AK, Schlater T, Fleming AW, Lou MA. Factors affecting outcome in pancreatic trauma. J Trauma. 1984;24(2):125-8.
Heitsch RC, Knutson CO, Fulton RL, Jones CE. Delineation of critical factors in the treatment of pancreatic trauma. Surg. 1976;80(4):523-9.
Lucas CE, Ledgerwood AM. Factors influencing outcome after blunt duodenal injury. J Trauma. 1975;15(10):839-46.
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.
Lin BC, Fang JF, Wong YC, Liu NJ. Blunt pancreatic trauma and pseudocyst: management of major pancreatic duct injury. Injury. 2007;38(5):588-93.
Asensio JA, Demetriades D, Hanpeter DE, Gambaro E, Chahwan S. Management of pancreatic injuries. Curr Prob Surg. 1999;36(5):325-419.
Gupta A, Kumar S, Yadav SK, Mishra B, Singhal M, Kumar A, et al. Magnitude, severity, and outcome of traumatic pancreatic injury at a level I trauma center in India. Indian J Surg. 2017;79:515-20.
Katz MG, Fenton SJ, Russell KW, Scaife ER, Short SS. Surgical outcomes of pancreaticoduodenal injuries in children. Pedia Surg Inter. 2018;34:641-5.
Fabian TC, Kudsk KA, Croce MA, Payne LW, Mangiante EC, Voeller GR, et al. Superiority of closed suction drainage for pancreatic trauma. A randomized, prospective study. Ann Surg. 1990;211(6):724.
Zhang D, Yan J, Siyin ST, Pang W, Chen Y. Nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children: a single center’s experience. BMC pediatrics. 2021;21(1):1-9.
Downloads
Published
How to Cite
Issue
Section
