DOCSLIB.ORG

Pancreatic Trauma

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Pancreatic Trauma Pancreas Trauma Dr. Michael R Aquino, MD, MHSc Assistant Professor of Medical Imaging Sick Kids Hospital, Toronto, ON, Canada I have no potential conflicts of interest to disclose. Learning Objectives • Identify the role of each imaging modality in the evaluation of pediatric patients with suspected blunt injury to the pancreas • Compare the advantages and disadvantages of each imaging modality used to evaluate the pediatric pancreas after blunt trauma • Describe how various techniques utilized in each modality could affect sensitivity and specificity for detecting pancreatic injury Management of Blunt Pancreatic Injury Injury Description of Injury Grade Minor contusion without duct injury I Superficial laceration without duct injury NON-OPERATIVE Major contusion without duct injury or tissue loss II Major laceration without duct injury or tissue loss NON-OPERATIVE VS OPERATIVE DEBATED III Distal transection or parenchymal injury with duct injury Large studies with conflicting findings IV Proximal transection or parenchymal injury involving ampulla NON-OPERATIVE PREFERRED Operative option is Whipple – more morbid operation which may have V Massive disruption of pancreatic head adverse long-term consequences Role of CT • Primary modality for evaluation of suspected blunt traumatic abdominal and pelvic injury in hemodynamically stable pediatric patients • Multiple algorithms / tools available to help decide which patients should be imaged CT Evaluation of Blunt Injury to the Pancreas • Main pancreatic duct integrity predicted based on depth of laceration • CT-based grading introduced by Wong Y, et al. CT Grade CT Findings A Pancreatitis and/or superficial laceration BI Deep laceration at distal pancreas BII Transections at distal pancreas CI Deep laceration at proximal pancreas CII Transection at proximal pancreas • Laceration >50% depth suspected to involve main pancreatic duct • Thought to be more reliable for body and tail, less reliable for head CT Evaluation of Blunt Injury to the Pancreas • Questionable accuracy of CT for identifying main pancreatic duct disruption • A few single center, small sample studies demonstrate high sensitivity • Phelan HA, et al. • Large multicenter retrospective study of MDCT for detecting pancreatic injury • Sn 52-54%, Sp 90-95% • CT unreliable in first 12-24 hours • Minimal early reactive edema • Close apposition of pancreatic transection fragments • Obscuration of laceration by surrounding hemorrhage, edema CT Protocol for Blunt Abdominal Trauma • FOV: Lower chest above diaphragms to symphysis pubis • Phase: Portal-venous • Contrast: IV contrast (2 mL/kg, max 120 mL), NO oral contrast • Image acquisition: • 0.625 mm • Reconstructed to 5 mm axial, and 3 mm coronal and sagittal images CT Protocol for Blunt Abdominal Trauma • Data do not support routine use of oral contrast • Eillison AM, et al • Minimal increased specificity for detecting any intra-abdominal injury • 84.7% (95% CI 82.2%-87.0%) vs 80.8% (95% CI 79.4%-82.1%) • Phelan H, et al • Oral contrast does not result in significant improvement in sensitivity of CT for detecting pancreatic ductal injury • Use delays study, increases risk of aspiration, may cause artifacts from air- contrast levels CT Protocol for Blunt Abdominal Trauma • Data does not support need for multiphasic pancreas protocol • Wong Y, et al • Single center, small sample prospective study with 6 proven duct injuries • Portal venous phase identified 6/6 duct disruptions and 3/3 normal ducts • Arterial/Parenchymal phase 2 false positives • Delayed/equilibrium phase 3 false negatives • Phelan HA, et al • Multicenter, retrospective study of MDCT detection of pancreas injury • Dedicated multiphasic pancreas protocol performed in 11% of cases but not associated with significant increase in sensitivity CT Protocol for Blunt Abdominal Trauma • Slice thickness • Phelan HA, et al • Multicenter, retrospective study of MDCT detection of pancreas injury • ~22% of studies with slice thickness ≤3 mm • No significant difference in sensitivity between studies with slice thickness ≤3 mm and ≥5 mm • Anderson S, et al & Itoh S, et al, & Faria S, et al • Several non-trauma-related studies demonstrate significant improved visualization of the main pancreatic duct with the use of thin-section MDCT (0.5 mm – 1.25 mm) • Panda A, et al • Single center study MDCT using 1.5 mm slice thickness and curved multiplanar reformatted images identified 18/19 duct disruptions • Must consider increased radiation exposure, noise, time to process CT Protocol for Blunt Abdominal Trauma • Curved planar reformations • Fukushima H, et al • Non-trauma-related studies have demonstrated improved visualization of the main pancreatic duct with the use of curved planar reformats • Panda A, et al • Recent single center study MDCT using 1.5 mm slice thickness and curved multiplanar reformatted images identified 18/19 duct disruptions • Requires time, post-processing Role of MRCP • Complementary to CT • Noninvasive technique to assess ductal integrity with high accuracy • Heavily T2-weighted sequences facilitate visualization of pancreaticobiliary tree MRCP Evaluation of Blunt Injury to Pancreas • Several predominantly adult studies demonstrate high sensitivity and specificity for identifying main pancreatic duct injury • Drake LM, et al • 31 patients with MRCP • Sn 91%, Sp 100% • Panda A, et al • 17 patients with MRCP, 3 pediatric • Sn 92%, Sp 100% • Houben C, et al • MRCP identified duct injury in 4 patients that had subsequent ERCP MRCP vs ERCP • MRCP • Noninvasive • Depicts entire abdomen including pancreatic parenchyma, peripancreatic fluid • Image duct upstream of injury • ERCP • May be diagnostic AND therapeutic • Potential for procedural complications • Ionizing radiation • May not be readily available MRCP Protocol Sequence Plane TR (ms) TE (ms) FOV (cm) Matrix Slice Thickness Respiration Compensation 3D T2 TSE Coronal 1000 864 ~30 256 x 205 2 mm, 1 mm gap Respiratory-triggered Fat Suppressed 2D T2 SS TSE Coronal 1000 740 ~30 320 x 256 40 mm radial slabs Breath-hold in older children, Fat Suppressed Radial angle 12.83 degree manual during shallower respiration in younger children 2D T2 SS TSE Coronal 3000 160 ~20 184 x 178 3 mm Respiratory-triggered Axial 3000 160 ~25 228 x 235 3 mm 3D T1 TFE Axial 500 50 ~20 320 x 256 1.5 mm Breath-hold Fat Suppressed 2D bSSFP Axial 500 50 ~37 268 x 429 5 mm TI 120 ms Respiratory-triggered 2D T2 TSE SPIR Axial 2000 80 ~37 376 x 300 5 mm, 1 mm gap Respiratory-triggered Fat Suppressed • Cardiac coil or pediatric body coil MRCP Protocol • No IV or oral contrast • No secretin MRCP Protocol • Smallest coil appropriate for size of child • Cardiac coil or pediatric body coil • Appropriate FOV to improve SNR • Effective respiratory compensation techniques • Fasting 4-6 h to reduce artifact from gas and fluid in adjacent bowel MRCP Protocol • 3.0T vs 1.5T • 3.0T high signal-to-noise ratio • Improved spatial resolution • Reduced scan time • More prone to dielectric effects and susceptibility artifacts • Isoda H, et al. & O’Regan DP, et al. • Significant improvement in image noise, SNR, and qualitative image quality at 3.0T • Trend but statistically insufficient improved visibility of the pancreatic duct at 3.0T • Onishi H, et al. • Significant improvement in visualization of pancreatic duct • No significant difference in homogeneity of signal intensity • Almehdar A and Chavahan G • Pediatric study demonstrated diagnostic quality of majority of MRCP exams sufficient to answer clinical question MRCP Protocol • 3D FSE vs SSFSE radial slab • 3D sequences with higher spatial resolution, higher SNR, MIP • Longer acquisition requiring respiratory triggering/navigator gating • Chavhan G, et al. • Pancreatic duct visualization better on SSFSE radial slab vs 3D FSE • Similar result in adult study by Lavdas E, et al. MRCP Protocol • Secretin • Stimulates pancreatic exocrine secretion, increases tone at sphincter of Oddi • Trout A, et al. • Minimal objective increase in pancreatic duct diameter • No significant subjective difference in image quality or pancreatic duct visibility • Gillams AR, et al. • Measured peripancreatic fluid collections after secretin administration in patients with pancreatic injury • Contributed to management of 12/17 patients; confirmed disruption and ongoing leak Role of US • FAST may have a role in triaging hemodynamically unstable • Holmes JF, et al. • Compared with standard care, FAST did not improve clinical care or resource utilization in hemodynamically stable children with blunt torso trauma • CT remains gold-standard imaging modality to evaluate blunt abdominal trauma in children Role of US • Naik-Mathuria BJ, et al. (Pediatric Trauma Society) • Proposed clinical pathway for nonoperative management of high-grade pediatric pancreatic injuries • US indicated in patients with progression/persistence of symptoms, worsening enzyme levels, inability to tolerate diet after a week, follow-up fluid collections US Evaluation of Blunt Injury to the Pancreas • Poor sensitivity for detecting pancreatic injury • Retroperitoneal midline position • Separation of transection fragments facilitates visualization • Useful for evaluating peripancreatic fluid CEUS of Blunt Injury to the Pancreas • Possible role in patients with low-energy impact trauma and isolated abdominal organ injuries, follow-up • Sessa B, et al. • Sn 96%, Sp 99%, PPV 98%, NPV 98% for detecting traumatic abdominal injury • LV F, et al. • Detected 21/22 blunt pancreatic injuries, including 6/7 ductal injuries Pancreas Trauma.
Load more

Recommended publications
  • Pancreatic Trauma from a Book
    JOP. J Pancreas (Online) 2004; 5(4):217-219. CASE REPORT Pancreatic Trauma from a Book Ismail H Mallick1, Muhammed H Thoufeeq2 1University Department of Surgery, Royal Free and University College Medical School. Hampstead, London, United Kingdom. 2General Medicine, Peterborough District General Hospital. Peterborough, Cambridgeshire, United Kingdom ABSTRACT injuries may occur as a result of penetrating or blunt trauma to the abdomen. Many blunt Context An early diagnosis of pancreatic injuries to the pancreas are not diagnosed trauma can be challenging and difficult early and end up with high morbidity and because of the lack of correlation between the mortality. We report an interesting case of initial presenting features, radiological and blunt pancreatic injury which was sustained in laboratory findings, and the severity of the a 40-year-old woman while she was carrying trauma. A high degree of suspicion is a book in front of her abdomen and essential to diagnose pancreatic injury accidentally collided against an edge of a particularly in patients with blunt trauma to door-frame. the abdomen. A computerised tomography scan is useful in making an early diagnosis of CASE REPORT pancreatic trauma, localizing the site of the injury and in the identification of main A 40-year-old woman presented with a 2-day pancreatic duct injury which has major history of constant epigastric pain with implications in the management of the patient. radiation to the back. She was of a thin habitus. She had previously been well. There Case report Here in, we report an interesting was no history of alcohol intake. She denied case of a 40-year-old woman who sustained a any history of abdominal trauma.
    [Show full text]
  • Surgical Management of Traumatic Pancreatic Injuries and Their Consequences
    International Surgery Journal El -Badry AM et al. Int Surg J. 2020 Nov;7(11):3555-3562 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: http://dx.doi.org/10.18203/2349-2902.isj20204656 Original Research Article Surgical management of traumatic pancreatic injuries and their consequences Ashraf Mohammad El-Badry, Mohamed Mahmoud Ali* Department of Surgery, Sohag University Hospital, Faculty of Medicine, Sohag University, Sohag, Egypt Received: 21 August 2020 Accepted: 07 September 2020 *Correspondence: Mohamed Mahmoud Ali, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce. Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS). Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%).
    [Show full text]
  • Case Report of Pancreatic-Preserving Surgical Drainage for Pancreatic Head Injury with Main Pancreatic Duct Injury
    Case Report iMedPub Journals Trauma & Acute Care 2020 www.imedpub.com Vol.5 No.3:83 ISSN 2476-2105 DOI: 10.36648/2476-2105.5.2.83 Case Report of Pancreatic-Preserving Surgical Drainage for Pancreatic Head Injury with Main Pancreatic Duct Injury Kojo M1*, Murata A2, Matsuda T1, Kagawa M1, Miyake T1, Tokuda H2, Okugawa K1 and Matsuyama S1 1Department of General Surgery, Kenwakai Otemachi Hospital, Kitakyushu, Kokurakitaku, Fukuoka, Japan 2Department of Emergency, Kenwakai Otemachi Hospital, Kitakyushu, Kokurakitaku, Fukuoka, Japan *Corresponding author: Kojo M, Department of General Surgery, Kenwakai Otemachi Hospital, Kitakyushu, Kokurakitaku, Fukuoka, Japan, E-mail: [email protected] Received date: July 30, 2020; Accepted date: August 13, 2020; Published date: August 20, 2020 Citation: Kojo M, Murata A, Matsuda T, Kagawa M, Miyake T, et al.(2020) Case Report of Pancreatic-Preserving Surgical Drainage for Pancreatic Head Injury with Main Pancreatic Duct Injury. Trauma Acute Care Vol.5 No.3: 83. DOI: 10.36648/2476-2105.5.3.83 Copyright: © 2020 Kojo M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. difficult to determine the optimal treatment strategy for pancreatic trauma. Furthermore, pancreatic surgery has long Abstract been considered to be a particularly challenging type of gastrointestinal surgery, requiring a high level of skill [3,4]. The incidence of pancreatic injury is low among trauma cases, and no clear treatment protocol has been As a treatment protocol for grades 4 and 5 injury of the established.
    [Show full text]
  • Intrahepatic Pancreatic Pseudocyst: Case Series
    JOP. J Pancreas (Online) 2016 Jul 08; 17(4):410-413. CASE SERIES Intrahepatic Pancreatic Pseudocyst: Case Series Dhaval Gupta, Nirav Pipaliya, Nilesh Pandav, Kaivan Shah, Meghraj Ingle, Prabha Sawant Department of Gastroenterology, Lokmanya Tilak Municipal Medical College &Hospital, Sion, Mumbai, India ABSTRACT Intrahepatic pseudocyst is a very rare complication of pancreatitis. Lack of experience and literature makes diagnosis and management of intrahepatic pseudocyst very difficult. Majority of published cases were managed by either percutaneous or surgical drainage. Less than 30 cases of intrahepatic pseudocysts have been reported in the literature and there is not a single report of endoscopic ultrasound guided management of intrahepatic pseudocysts. Here we report a case series of 2 patients who presented with intrahepatic pseudocysts and out of which first case was successfully managed by EUS guided drainage. Our second case is also the youngest patient presented with intrahepatic pseudocyst till now. INTRODUCTION abdominal distention since last 1 month. However he did located in or around t not have significant weight loss, gastrointestinal bleeding, A pancreatic pseudocyst is a collection of pancreatic fluid pedal edema, jaundice, fever. His past medical history and he pancreas. Pancreatic pseudocysts family history was not significant. He was chronic alcoholic are encased by a non-epithelial lining of fibrous, necrotic since last 15 years with intake of approximately 90 gram and granulation tissue secondary to pancreatic injury.
    [Show full text]
  • Traumatic Pseudocyst of the Pancreas - a Case Report
    Med. J. Malaysia Vol. 44 No. 4 December 1989 Traumatic pseudocyst of the pancreas - A case report Samuel K.S. Tay, MBBS (Mal), FRCS (Glasg), FRCS (Edin) Lecturer Department ofSurgery, Faculty ofMedicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda, 50300 Kuala Lumpur. Yusha Abdul Wahab, MBBS (Mal), FRCS (Edin), Consultant General and Vascular Surgeon General Hospital Kuala Terengganu Summary Blunt trauma to the pancreas is not common. The pancreatic injury can range from simple bruising to complete transection often associated with other visceral injuries. Pseudocyst ofthe pancreas is a late complication presenting usually within six weeks of the injury. The treatment of choice is distal pancreate~omy. Key words: Pancreas, pancreatectomy, trauma, pseudocyst. Introduction Blunt injuries to the pancreas are not common since it lies retroperitoneally. However as it straddles the first lumbar vertebra, it may be crushed against the vertebral body by a severe force or a milder but sudden one to the upper abdomen before the abdominal musculature has had time to guard against it. Other viscerae, e.g. the duodenum, are often simultaneously injured either because of the considerable force sustained or because of their close association with the pancreas. Isolated injury to the pancreas is rare. It was first reported in 1856 and since then there have been several of such cases.' We report here a case of blunt trauma to the pancreas complicated by the development of a pseudocyst. Case report M.R. a 22 year old Malay man was involved in a road traffic accident while riding his motorcycle. He sustained abrasions on the epigastrium and a fracture of the neck of his left femur.
    [Show full text]
  • Injuries to the Pancreatic Head
    PANCREATIC INJURY IN CHILDREN Controversy and Current Management Accidental Trauma in Children ● 9.2 million medical visits for accidental trauma ● 151,000 hospitalizations for accidental trauma ● >16% of accidental trauma results in permanent injury ● Accidental trauma is the leading cause of death in people <18 yrs of age ● 30 deaths per day Epidemiology ABDOMINAL TRAUMA—10% of all injuries in children. #1 Spleen #2 Liver #3 Kidney #4 Pancreas—3% to 12% of blunt abdominal trauma Scenario 1-Isolated injury from blunt blow. Scenario 2-Multisystem trauma ie MVA, ATV associated injury as high as 60% Relevant Anatomy • Proximity of vascular structures to the head of the pancreas has a marked effect on the morbidity and mortality. – Subhepatic IVC and the aorta sit just posterior to the pancreatic head to the patient's right side – Superior mesenteric vein coalesces into the portal vein immediately behind the pancreas – Splenic artery (off the celiac trunk) and vein (draining into the portal vein) run superior and posterior to the body and tail of the pancreas and are relatively easier to expose and control compared to the IVC and portal vein PHYSIOLOGIC PADDING ADULT ABDOMEN: -posteriorly protected by thick musculature -anteriorly protected by rectus and abdominal musculature and energy absorbing liver,colon, stomach, duodenum, and small bowel “physiologic padding” CHILD ABDOMEN: -Rib cage higher, muscles less developed, organ more mobile, less fat. No “physiologic padding” Duodenal Hematoma • Duodenal Hematoma Duodenal Hematoma The Chance Fx Hyperflexion injury during Chance Fracture sudden deceleration. Anterior vertebral compression-ligament rupture. Associated intrabdominal injuries. Presentation • A high degree of clinical suspicion is necessary to ensure that pancreatic injuries are not overlooked or missed • The type of injury (ie, blunt vs penetrating) and information about the injuring agent (eg, GSW, knife) help focus the clinician on the possibility of pancreatic injury.
    [Show full text]
  • Isolated Pancreatic Transection Secondary to Abdominal Blunt Trauma - a Case Report
    Jemds.com Case Report Isolated Pancreatic Transection Secondary to Abdominal Blunt Trauma - A Case Report Birju Patel1, Harish Chauhan2, Jignesh Savsaviya3, Purandar Ribadia4, Purva Kothari5 13rd Year Resident Department of General surgery, SMIMER Hospital, Surat, Gujarat, India. 2Professor, Department of General surgery, SMIMER Hospital, Surat, Gujarat, India. 3Assistant Professor, Department of General surgery, SMIMER Hospital, Surat, Gujarat, India. 42nd Year Resident, Department of General surgery, SMIMER Hospital, Surat, Gujarat, India. 52nd Year Resident, Department of General surgery, SMIMER Hospital, Surat, Gujarat, India. PRESENTATION OF CASE An 8-year-old boy presented to the Emergency Department after trauma by a bicycle Corresponding Author: hand, with injury over inferior thoracic and epigastric region. GCS: 15/15. HR: Dr. Birju Patel, A-26, Tirupati Township Part 1, 140/min. SPO2: 98%. Past medical history was not significant. Clinically, his abdomen Deesa Highway, Palanpur, was soft with tenderness over the left hypochondrium and tenderness with a Banaskantha-385001, Gujarat, India. patterned bruise of approximately 3*1 cms over the epigastrium. There were no E-mail: [email protected] features of peritonitis. Laboratory tests reported raised leucocytic count of 14,400 per dL and raised levels of serum amylase (1478 U/L). A contrast enhanced computed DOI: 10.14260/jemds/2019/576 tomographic study of abdomen and pelvis suggested a large peripheral enhancing collection measuring approximately 37 (AP)*45 (TRANS)*55 (SI) mm replacing the Financial or Other Competing Interests: entire thickness of neck of pancreas and extending into the peripancreatic fat over None. anterior aspect of head, neck, uncinate process and proximal body of pancreas, with How to Cite This Article: eccentric non-enhancing hypodense area within representing blood clots.
    [Show full text]
  • The Management of Complex Pancreatic Injuries
    SAJS Review The management of complex pancreatic injuries J. E. J. KRIGE1,3, M.B. CH.B., F.A.C.S., F.R.C.S. (ED.), F.C.S. (S.A.) S. J. BENINGFIELD2, M.B. CH.B., F.F.RAD. (S.A.) A. J. NICOL1,4, M.B. CH.B., F.C.S. (S.A.) P. NAVSARIA1,4, M.B. CH.B., F.C.S. (S.A.) Divisions of Surgery1 and Radiology2, Faculty of Health Sciences, University of Cape Town, and Surgical Gastroenterology3 and Trauma Unit4, Groote Schuur Hospital, Cape Town Summary remote from the main pancreatic duct), without visible duct involvement, are best managed by external drainage; (ii) major lacerations or gunshot or stab wounds in the Major injuries of the pancreas are uncommon, but may body or tail with visible duct involvement or transection of result in considerable morbidity and mortality because of more than half the width of the pancreas are treated by the magnitude of associated vascular and duodenal distal pancreatectomy; (iii) stab wounds, gunshot wounds injuries or underestimation of the extent of the pancreatic and contusions of the head of the pancreas without devi- injury. Prognosis is influenced by the cause and complex- talisation of pancreatic tissue are managed by external ity of the pancreatic injury, the amount of blood lost, dura- drainage, provided that any associated duodenal injury is tion of shock, speed of resuscitation and quality and amenable to simple repair; and (iv) non-reconstructable nature of surgical intervention. Early mortality usually injuries with disruption of the ampullary-biliary-pancreatic results from uncontrolled or massive bleeding due to union or major devitalising injuries of the pancreatic head associated vascular and adjacent organ injuries.
    [Show full text]
  • Management of Pancreatic Injuries After Blunt Abdominal Trauma
    JOP. J Pancreas (Online) 2009 Nov 5; 10(6):657-663. ORIGINAL ARTICLE Management of Pancreatic Injuries after Blunt Abdominal Trauma. Experience at a Single Institution Ker-Kan Tan, Diana Xinhui Chan, Appasamy Vijayan, Ming-Terk Chiu TTSH-NNI Trauma Centre, Tan Tock Seng Hospital. Singapore, Singapore ABSTRACT Context Pancreatic injuries after blunt abdominal trauma could result in significant morbidity, and even mortality if missed. Objective Our aim was to review our institution’s experience with blunt pancreatic trauma. Setting Our study included all cases of blunt traumatic pancreatic injuries. Patients Sixteen patients (median age 41 years; range: 18-60 years) were treated for blunt pancreatic trauma from December 2002 to June 2008. Main outcome measure Pancreatic injuries were graded according to the definition of the American Association for the Surgery of Trauma (AAST). Results CT scans were performed on 10 (62.5%) patients, with the remaining 6 (37.5%) sent to the operating theatre immediately due to their injuries. Of the 12 (75.0%) patients who underwent exploratory laparotomy, 2 (12.5%) had a distal pancreatectomy (AAST grade III), 1 (6.3%) underwent a Whipple procedure (AAST grade IV) while another 2 (12.5%) were too hemodynamically unstable for any definitive surgery (AAST grade IV and V); the remaining 7 (43.8%) pancreatic injuries were managed conservatively. Four (25.0%) patients had their injuries managed non-operatively. Some of the associated complications included intra-abdominal collection (n=2, 12.5%) and chest infection (n=2, 12.5%). Conclusion Blunt pancreatic trauma continues to pose significant diagnostic and therapeutic challenges.
    [Show full text]
  • Operative Strategies in Pancreatic Trauma – Keep It Safe and Simple
    SAJS Editorial Operative strategies in pancreatic trauma – keep it safe and simple Injuries to the pancreas are infrequently encountered in surgical ing the pancreas and those resulting from associated injuries. practice but may result in substantial morbidity and mortality if These inconsistencies have led to widely disparate and incongruent pancreatic, visceral vascular and adjacent organ injuries occur in results. A wide variety of pancreatic injury severity grades exist, combination.1-4 Recent data indicate a rising incidence of pancre- and their prime use is for comparative epidemiological studies of atic trauma owing to high-speed car accidents and an escalation outcome. There is still no concise and universally accepted classifi- in civil violence involving increasingly dangerous weapons.1-4 In cation system that predicts the outcome of pancreatic injuries and South African and North American cities, penetrating abdominal allows the formulation of a rational management plan for the indi- injuries from gunshot wounds are the most common cause of pan- vidual. Optimal intervention is further hampered by the persisting creatic trauma, while in Western Europe, England and Australia, description of a raft of different surgical techniques, some of which traffic accidents predominate.4-7 The mechanism of injury dictates have survived transcription from outdated sources and are now intervention. After penetrating injuries, the diagnosis is usually wholly inappropriate and should be expunged from the surgical established at laparotomy, while in those who have sustained blunt lexicon. It is not surprising, therefore, that the neophyte surgeon, polytrauma, pancreatic injuries are generally detected by radiologi- battling in the trenches to understand the concepts and apply logi- cal investigations, allowing some patients to be managed without cal treatment principles to pancreatic injuries through the fog of recourse to surgery.
    [Show full text]
  • Endoscopic Management of Pancreatic Duct Disruption Following a Bullet Injury: a Case Report
    JOP. J Pancreas (Online) 2009 May 18; 10(3):318-320. CASE REPORT Endoscopic Management of Pancreatic Duct Disruption Following a Bullet Injury: A Case Report Mukul Rastogi, Brajendra Prasad Singh, Adnan Rafiq, Manav Wadhawan, Ajay Kumar Department of Gastroenterology and Hepatology, Indraprastha Apollo Hospitals. Sarita Vihar, New Delhi, India ABSTRACT Context A pancreatic fistula is the most common complication of pancreatic injury. Although spontaneous closure of pancreatic ductal disruption has been reported, surgical treatment is accepted as the single most carried-out intervention in major ductal injury. We report a case of pancreatic duct disruption due to a bullet injury managed successfully by endoscopic pancreatic duct stenting. Case report A 28-year old male sustained a bullet injury leading to proximal pancreatic duct disruption with leakage of dye. After a month of unsuccessful conservative management, graded endoscopic pancreatic duct stenting was carried out, leading to closure of the leak. The patient has gained 15 kilograms of weight at one year of follow-up without any complications. Conclusion This is probably the first case of successful endoscopic management of pancreatic duct disruption due to a bullet injury. In carefully selected patients, successful non-surgical management of traumatic pancreatic duct disruption is feasible. INTRODUCTION the pancreas with the bullet lodging between the L2-L3 vertebrae. He went into hypovolemic shock. Injuries to the pancreas are rare and account for 1-4% Resuscitation with exploratory laparotomy (repair of of severe abdominal injuries [1]. In 60-80% of patients the liver, inferior vena cava and pylorus) was carried with pancreatic injuries, damage to surrounding organs out at a local hospital.
    [Show full text]
  • Traumatic Pancreatitis in Children
    Academic Journal of Pediatrics & Neonatology ISSN 2474-7521 Case Report Acad J Ped Neonatol Volume 2 Issue 3 - December 2016 Copyright © All rights are reserved by Danica Stanic DOI: 10.19080/AJPN.2016.02.555588 Traumatic Pancreatitis in Children Danica Stanic*, Goran Rakic, Biljana Draskovic and Anna Uram-Benka Institute for the Healthcare of Children and Youth of Vojvodina, Serbia Submission: October 01, 2016; Published: December 13, 2016 *Corresponding author: Tel: ; E-mail: Danica Stanić, Institut za zdravstvenu zaštitu dece i omladine Vojvodine, Hajduk Veljkova 10, 21000 Novi Sad, Serbia, Abstract Traumatic pancreatitis is still a relative enigma, despite modern clinical practice, technology and modern diagnostic procedures. This condition is very specific and serious and is associated with significant morbidity, especially in pediatric population. Traumatic pancreatitis is also an emerging problem in pediatric population with its incidence rising in the last 20 years. Data regarding the optimal management and physician practice patterns are lacking. We present a literature review and updates on the management of pediatric pancreatitis due to trauma.Keywords: Prospective multicenter studies are necessary to guide care and improve outcomes for this population. Trauma; Pancreas; Children; Diagnosis; Management Introduction in children [8]. According to the American Association for the Traumatic pancreatitis is still a relative enigma, despite modern Surgery of Trauma, the guidelines for pancreatic injuries are: clinical practice, technology and modern diagnostic procedures. laceration; This condition is very specific and serious and is associated with Grade I: minor contusion without duct injury or superficial significant morbidity, especially in pediatric population. Pancreatic injury is the fourth most common abdominal Grade II: major contusion or laceration without duct injury or organ injury (following injuries of the spleen, liver and kidneys) tissue loss; [1].
    [Show full text]