scholarly journals Imaging of Pancreatic Trauma—A Clinical Scenario-Based Approach

2020 ◽  
Vol 3 (01) ◽  
pp. 028-034
Author(s):  
Naren Hemachandran ◽  
Shivanand Gamanagatti
Keyword(s):  
Magnetic Resonance ◽  
Abdominal Trauma ◽  
Clinical Signs ◽  
Vascular Complications ◽  
Pancreatic Injury ◽  
High Morbidity ◽  
Pancreatic Trauma ◽  
Clinical Scenarios ◽  
Management Of Complications ◽  
Secondary Signs

AbstractPancreatic injury, although uncommon in the setting of abdominal trauma, is associated with high morbidity and mortality. While the clinical signs are nonspecific, the imaging signs can be very subtle in the early stages leading to missed injuries that present later as complications. Contrast-enhanced computed tomography (CT) is the main workhorse and initial imaging modality in the setting of abdominal trauma, while magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography is used as a problem-solving tool in pancreatic trauma.This article provides a review of the imaging of pancreatic trauma and has been organized into common clinical scenarios–Suspected pancreatic injury with normal-appearing pancreas on CT; definite pancreatic injury on CT, late presentation or complication in a patient with pancreatic injury. The role of the radiologist in each scenario is described as follows: to identify subtle secondary signs of injury and resort to MRI or a repeat imaging wherever necessary in a suspected pancreatic injury with normal-appearing pancreas on CT (Scenario 1); to look for primary/hard signs, grade the injury according to American Association of Surgery for Trauma Organ Injury Scale, and utilize MRI if necessary to ascertain the presence of ductal injury when a definite pancreatic injury is seen on CT (Scenario 2); and to diagnose various complications and help in the management of complications such as draining collections or vascular complications like pseudoaneurysms (Scenario 3).Radiologists should be aware of the primary and secondary signs of pancreatic injury so as to enable prompt diagnosis and further management. Radiologists play an important role not only in the diagnosis of pancreatic injuries but also in the management of certain complications.

Pancreatic Trauma

2019 ◽  
Author(s):  
James C. Becker ◽  
Brian C. Beldowicz ◽  
Gregory J. Jurkovich
Keyword(s):  
Pediatric Trauma ◽  
Pancreatic Injury ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Rare Occurrence ◽  
Pancreatic Trauma ◽  
Spleen Preserving ◽  
Pancreatic Injuries ◽  
Trauma Injury

Pancreatic injury continues to present challenges to the trauma surgeon. The relatively rare occurrence of these injuries (0.2–12% of abdominal trauma), the difficulty in making a timely diagnosis, and high morbidity and mortality rates following complications justify the anxiety these unforgiving injuries invoke 1-3. Mortality rates for pancreatic trauma range from 9 to 34%, with a mean rate of 19%. Complications following pancreatic injuries are alarmingly frequent, occurring in 30 to 60% of patients 4. Nonetheless, if recognized early, the treatment of most pancreatic injuries is straightforward, with low morbidity and mortality. This review contains 10 figures, 2 tables, and 65 references. Key Words : Pancreatic trauma, injury, pediatric trauma, ERCP, MRCP, spleen-preserving pancreatectomy

Spleen-preserving distal pancreatectomy following grade III pancreatic injury in a delayed presentation: a technical challenge

2021 ◽  
Vol 14 (6) ◽  
pp. e242721
Author(s):  
Venu Bhargava Mulpuri ◽  
Dinesh Kumar Bhuria ◽  
Surinder Rana ◽  
Rajesh Gupta
Keyword(s):  
Management Strategies ◽  
Splenic Vein ◽  
Clinical Signs ◽  
Posterior Wall ◽  
Pancreatic Injury ◽  
Solid Organ ◽  
Delayed Presentation ◽  
Pancreatic Trauma ◽  
Spleen Preserving ◽  
Duct Disruption

Pancreatic injuries are often overlooked in view of subtle clinical signs, and high index of suspicion is required to manage these injuries. Management strategies vary depending on the grade of injury and associated solid organ injuries and vascular injuries. Early surgery is advised in patients with duct disruption to avoid complications related to duct disruption. We present a case of 19-year-old man with delayed presentation following pancreatic trauma. During the surgery, changes of pancreatitis were noted and posterior wall of the stomach was adherent to pancreas, and inflammatory changes in vicinity of pancreas posed a significant challenge while dissecting pancreas away from the splenic vein. Spleen-preserving distal pancreatectomty (SPDP) was done. SPDP is time-consuming and technically challenging procedure especially in patients with delayed presentation. It is safe and feasible to consider spleen preservation in pancreatic trauma when patient is haemodynamically stable and expertise is available.

scholarly journals Management of Pancreatic Trauma in Urban India: A Multicenter Study

2021 ◽  
Author(s):  
Devi Bavishi ◽  
Monty Khajanchi ◽  
Ramlal Prajapati ◽  
Anita Gadgil ◽  
Bhakti Sarang ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Associated Injuries ◽  
Pancreatic Trauma ◽  
Level Of Evidence ◽  
Mortality And Morbidity ◽  
Care Outcomes ◽  
Multicenter Prospective Observational Study

Abstract BackgroundPancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1–12% of patients with penetrating trauma. The mortality and morbidity rates range from 9-34% and 30-60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India.MethodsWe analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’.ResultsOf the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), bowel (14) and spleen (13) were the most common associated injuries.ConclusionConservative management was as common as operative management in patients with pancreatic injuries. Most (80%) grade III/IV underwent operative treatment. Many patients (82%) had associated injuries. Level of evidence: III

Conservative surgery for pancreatic neck transection

2015 ◽  
Vol 87 (6) ◽  
Author(s):  
Divya Dahiya ◽  
Surinder Singh Rana ◽  
Lileswar Kaman ◽  
Arunanshu Behera
Keyword(s):  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Conservative Surgery ◽  
Pancreatic Injury ◽  
High Morbidity ◽  
Solid Organ ◽  
Lesser Sac ◽  
Pancreatic Neck ◽  
Isolated Pancreatic Injury ◽  
Immediate Surgery

AbstractPancreas is the fourth solid organ injured in blunt abdominal trauma. Isolated pancreatic injury is present in less than 1% of patients. As it is associated with high morbidity and mortality, management is controversial.Isolated pancreatic trauma cases with pancreatic neck transection following blunt abdominal trauma were analyzed. All these patients were treated with immediate surgery involving lesser sac drainage and feeding jejunostomy only.Authors conclude that lesser sac drainage can be used as an alternative to distal pancreatectomy or pancreaticojejunostomy or pancreaticogastrostomy.

scholarly journals Современные технологии диагностики и лечения травм поджелудочной железы

2021 ◽  
Vol 14 (3) ◽  
Author(s):  
F Khadjibaev ◽  
Sh Atadjanov ◽  
K Rizaev ◽  
A Mustafaev ◽  
A Askarov
Keyword(s):  
Computed Tomography ◽  
Surgical Treatment ◽  
Magnetic Resonance ◽  
Ultrasound Examination ◽  
Clinical Signs ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Clinical Problem ◽  
Abdominal Injuries ◽  
Pancreatic Trauma ◽  
Initial Symptoms

Pancreatic trauma is rare from 0.2% to 12% of abdominal injuries, but presents a complex clinical problem due to the erased initial symptoms and the absence of specific clinical signs, which lead to late diagnosis and delay surgical treatment. The symptoms of pancreatic trauma are nonspecific and often masked by trauma to other organs. In this regard, this article separately considers the issues of radiation diagnostics (ultrasound examination, multispiral computed tomography, magnetic resonance cholangiopancreatography, retrograde cholangiopancreatography, laparoscopy) and the choice of tactics for the treatment of рancreatic trauma.

scholarly journals Management of Pancreatic Trauma In Urban India: A Multicenter Study

2021 ◽  
Author(s):  
Devi Bavishi ◽  
Monty Khajanchi ◽  
Ramlal Prajapati ◽  
Anita Gadgil ◽  
Bhakti Sarang ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Associated Injuries ◽  
Pancreatic Trauma ◽  
Level Of Evidence ◽  
Mortality And Morbidity ◽  
Care Outcomes ◽  
Multicenter Prospective Observational Study

Abstract Background: Pancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1–12% of patients with penetrating trauma. The mortality and morbidity rates range from 9-34% and 30-60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India.Methods: We analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’.Results: Of the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), bowel (14) and spleen (13) were the most common associated injuries.Conclusion: Conservative management was as common as operative management in patients with pancreatic injuries. Most (80%) grade III/IV underwent operative treatment. Many patients (82%) had associated injuries. Level of evidence: III

scholarly journals Brain Abscess Caused by Nocardia: Case Report and Literature Review

2020 ◽  
Author(s):  
Guilherme Finger ◽  
Maria Eduarda Conte Gripa ◽  
Tiago Paczko Bozko Cecchini ◽  
Tobias Ludwig do Nascimento
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Brain Abscess ◽  
Clinical Signs ◽  
Occipital Lobe ◽  
High Morbidity ◽  
Rare Clinical Entity ◽  
Brain Abscesses

AbstractNocardia brain abscess is a rare clinical entity, accounting for 2% of all brain abscesses, associated with high morbidity and a mortality rate 3 times higher than brain abscesses caused by other bacteria. Proper investigation and treatment, characterized by a long-term antibiotic therapy, play an important role on the outcome of the patient. The authors describe a case of a patient without neurological comorbidities who developed clinical signs of right occipital lobe impairment and seizures, whose investigation demonstrated brain abscess caused by Nocardia spp. The patient was treated surgically followed by antibiotic therapy with a great outcome after 1 year of follow-up.

scholarly journals Changes of Dorsal Root Ganglion Volume in Dogs with Clinical Signs of Degenerative Myelopathy Detected by Water-Excitation Magnetic Resonance Imaging

Animals ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 1702
Author(s):  
Eiji Naito ◽  
Kohei Nakata ◽  
Yukiko Nakano ◽  
Yuta Nozue ◽  
Shintaro Kimura ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Spinal Cord ◽  
Magnetic Resonance ◽  
Clinical Signs ◽  
Intervertebral Disc Herniation ◽  
Resonance Imaging ◽  
Diagnostic Potential ◽  
Water Excitation ◽  
Spinal Cord Segment ◽  
Degenerative Myelopathy

Canine degenerative myelopathy (DM) is a progressive and fatal neurodegenerative disease. However, a definitive diagnosis of DM can only be achieved by postmortem histopathological examination of the spinal cord. The purpose of this study was to investigate whether the volumetry of DRG using the ability of water-excitation magnetic resonance imaging (MRI) to visualize the DRG in dogs has premortem diagnostic value for DM. Eight dogs with DM, twenty-four dogs with intervertebral disc herniation (IVDH), and eight control dogs were scanned using a 3.0-tesla MRI system, and water-excitation images were obtained to visualize and measure the volume of DRG, normalized by body surface area. The normalized mean DRG volume between each spinal cord segment and mean volume of all DRG between T8 and L2 in the DM group was significantly lower than that in the control and the IVDH groups (P = 0.011, P = 0.002, respectively). There were no correlations within the normalized mean DRG volume between DM stage 1 and stage 4 (rs = 0.312, P = 0.128, respectively). In conclusion, DRG volumetry by the water-excitation MRI provides a non-invasive and quantitative assessment of neurodegeneration in DRG and may have diagnostic potential for DM.

scholarly journals AB1076 COLOR DOPPLER HIGH- FREQUENCY ULTRASOUND OF DIGITAL ARTERIES IN PATIENTS WITH SYSTEMIC SCLEROSIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1827.3-1827
Author(s):  
O. Alekseeva ◽  
N. Yudkina ◽  
A. Demina ◽  
A. Volkov ◽  
E. Nasonov
Keyword(s):  
Blood Flow ◽  
Systemic Sclerosis ◽  
Color Doppler ◽  
Laboratory Data ◽  
Clinical Signs ◽  
Vascular Complications ◽  
Nailfold Capillaroscopy ◽  
Exclusion Criterion ◽  
Digital Ulcers ◽  
Linear Probe

Background:Systemic sclerosis (SSc) can lead to vascular complications such as digital ulcers or pitting scars (DU/PS). These changes develop in most patients with SSc and exacerbate their condition. However, there are no methods for dynamic assessment of the vascular involvement. The dynamics of capillaroscopic changes is very slow.Objectives:The aim of the study was to compare blood flow parameters of digital arteries in SSc patients and healthy individuals and to compare with nailfold capillaroscopy and clinical signs of ischemia (DU/PS).Methods:32 SSc patients, mean age 49,5 [42,0; 59,0] yrs and 26 ‘healthy’, mean age 43,5 [33,0; 57,0], were included. Groups of patients differed by gender and age. The exclusion criterion was the presence of obliterating vascular disease of the upper extremities. An Esaote MyLab Twice US system with 22 MHz linear probe was used. A total of SSc patients and controls underwent Color Doppler ultrasonography (CDUS) of 376 (256 + 208) digital arteries to compare blood flow velocity, resistive indices (RIs) and presence of occlusion. Nailfold capillaroscopy, clinical and laboratory data were also evaluated.Results:In digital arteries, pulsatility index (PI), peak systolic velocity (PSV) and end-diastolic velocity (EDV) were significantly lower and RI higher in SSc patients compared with controls (PSV: 13,28 [9,88; 16,7] vs17,45 [12,65; 22,5] cm/s, p=0,008; EDV: 2,68 [1,78, 4,05] vs 6,37 [4,75; 8,5] cm/s, p=0,000; RI: 0,78 [0,69; 0,81] vs 0,68 [0,59; 0,74], p=0,005; PI: 1,73 [1,32; 2,19] vs 1,22 [0,99; 1,55], p=0,002).We did not find any correlation between two methods. Also, we did not reveal any correlation between DU/PS, clinical, laboratory data and CDUS, but we found relationship between DU/PS and avascular areas or capillaroscopic findings (r= 0,37, p=0,045 and r= 0,40, p=0,03 correspondingly).Conclusion:Blood flow is significantly decreased in digital arteries in SSc, but clinical features of vasculopathy depend on microcirculatory disorders. It is important to continue research to find methods for dynamic evaluation of microcirculatory changes.References:noDisclosure of Interests:None declared

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