Current Status and Management of Pancreatic Trauma with Main Pancreatic Duct Injury: A Multicenter Nationwide Survey in Japan

IntroductionPancreatic trauma is potentially lethal despite recent improvements in surgical techniques and conservative management. However, no guidelines for the management of pancreatic trauma have been established. In this report, we propose an algorithm for the management of pancreatic trauma based on our experience of nine cases and a literature review.Case presentationThis study included nine patients with pancreatic trauma (five men and four women). The patients’ median age was 40 years (range, 17–75 years). The overall mortality rate was 22.2%, and the postoperative mortality rate was 16.7%. Superficial trauma was present in two patients. Deep trauma without injury to the main pancreatic duct was present in one patient, and this patient was treated successfully with endoscopic nasopancreatic drainage. Active bleeding was present in two patients and controlled by interventional radiology. Deep trauma with injury to the main pancreatic duct was present in six patients. Among them, one patient died after conservative treatment with endoscopic nasopancreatic drainage. The other five patients underwent surgery (pancreatic resection in four and necrosectomy in one).ConclusionThe herein-described algorithm recommends interventional radiology for active arterial bleeding, conservative management for trauma without ductal injury, and surgery for trauma with ductal injury. This algorithm may provide a basis for future establishment of guidelines.

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Novel Promising Technique for Traumatic Pancreatic Injury Management.

10.21203/rs.3.rs-35661/v1 ◽

2020 ◽

Author(s):

Mohammed Hamada Takrouney ◽

Vipul Prakash Bothara ◽

Bhushan Jahhav ◽

Mohamed Abdelkader Osman ◽

Ibrahim Ali Ibrahim ◽

...

Keyword(s):

Pancreatic Duct ◽

Median Time ◽

Main Pancreatic Duct ◽

Primary Repair ◽

Pancreatic Injury ◽

Pancreatic Trauma ◽

Average Hospital ◽

Pancreatic Injuries ◽

The Status ◽

Average Operative Time

Abstract Introduction: Pancreatic injuries in children are relatively uncommon. The precise location of the injury, the status of the main pancreatic duct, and the time between diagnosis and intervention are a potentially useful guide for management decisions. We report a successful endoscopic simple primary repair with the pancreatic preservation even with transected main pancreatic duct without duct stenting.Patients and Methods: Between May 2017and December 2019, 3 patients with pancreatic trauma and duct transection underwent endoscopic (laparoscopic and robotic) repair. Demographics, Operative data, Postoperative complications, and clinical outcomes were documented and analyzed.Results: Three patients with pancreatic fractures, 2 patients with grade IV, and one patient grade III injury. The median age was 11 years, the median time of hospital admission after the trauma was 72 hours. The median time of surgical intervention was 24 hours. Average operative time was160 minute and the average hospital stay was 9 days with no recorded postoperative or follow up complications till now.Conclusion: Primary simple pancreatic repair is a promising and plausible technique for the management of pancreatic trauma, especially with duct transaction it maybe instead of all other modalities of pancreatic trauma treatment. We implore all pediatric surgery centers to espouse this technique.

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Pancreatic trauma with main pancreatic duct injury

Journal of Hepato-Biliary-Pancreatic Sciences ◽

10.1002/jhbp.973 ◽

2021 ◽

Author(s):

Jake Krige ◽

Eduard Jonas

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Pancreatic Trauma

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Successful nonoperative management by endoscopic and percutaneous drainage for penetrating pancreatic duct injury: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02647-8 ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Hiroki Kanno ◽

Yusuke Hirakawa ◽

Masafumi Yasunaga ◽

Ryuta Midorikawa ◽

Shinichi Taniwaki ◽

...

Keyword(s):

Pancreatic Duct ◽

Percutaneous Drainage ◽

Main Pancreatic Duct ◽

Nonoperative Management ◽

Pancreatic Head ◽

Pancreatic Injury ◽

High Grade ◽

Pancreatic Trauma ◽

Contrast Enhanced ◽

Grade Iii

Abstract Background Pancreatic trauma is a rare condition with a wide presentation, ranging from hematoma or laceration without main pancreatic duct involvement, to massive destruction of the pancreatic head. The optimal diagnosis of pancreatic trauma and its management approaches are still under debate. The East Association of Surgery for Trauma (EAST) guidelines recommend operative management for high-grade pancreatic trauma; however, several reports have reported successful outcomes with nonoperative management (NOM) for grade III/IV pancreatic injuries. Herein, we report a case of grade IV pancreatic injury that was nonoperatively managed through endoscopic and percutaneous drainage. Case presentation A 47-year-old Japanese man was stabbed in the back with a knife; upon blood examination, both serum amylase and lipase levels were within normal limits. Contrast-enhanced computed tomography (CT) showed extravasation of the contrast medium around the pancreatic head and a hematoma behind the pancreas. Abdominal arterial angiography revealed a pseudo aneurysm in the inferior pancreatoduodenal artery, as well as extravasation of the contrast medium in that artery; coil embolization was thus performed. On day 12, CT revealed a wedge-shaped, low-density area in the pancreatic head, as well as consecutive pseudocysts behind the pancreas; thereafter, percutaneous drainage was performed via the stab wound. On day 22, contrast radiography through the percutaneous drain revealed the proximal and distal parts of the main pancreatic duct. The injury was thus diagnosed as a grade IV pancreatic injury based on the American Association for the Surgery of Trauma guidelines. On day 26, an endoscopic nasopancreatic drainage tube was inserted across the disruption; on day 38, contrast-enhanced CT showed a marked reduction in the fluid collection. Finally, on day 61, the patient was discharged. Conclusions Although the EAST guidelines recommend operative treatment for high-grade pancreatic trauma, NOM with appropriate drainage by endoscopic and/or percutaneous approaches may be a promising treatment for grade III or IV trauma.

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