scholarly journals 1418 Non-Operative Versus Operative Management for Blunt Pancreatic Trauma in Adults: A Systematic Review of The Literature

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
N Al-Saadi ◽  
S Froghi
Keyword(s):  
Systematic Review ◽  
Management Strategy ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Organ Injury ◽  
Pancreatic Trauma ◽  
Severity Of Injury ◽  
Increase Risk ◽  
Blunt Pancreatic Trauma ◽  
Accepted Practice

Abstract Aim Pancreatic injury, a rare consequence of blunt abdominal trauma, is associated with significant morbidity and mortality when the appropriate management is delayed. Due to the rarity of the injury, there is currently a lack of evidence to establish a treatment pathway for adults. The aim of this review was to compare outcomes following non-operative and operative management of adults who suffered blunt pancreatic trauma injuries. Method An electronic literature search was performed from 2008 to 2020. Studies pertaining to adults sustaining blunt pancreatic injuries, of all grades (I-V) of severity, according to the American Association for the Surgery of Trauma, were included. The primary outcome was mortality, whilst secondary outcomes were components of pancreas specific morbidity. 1501 studies were initially identified and screened, and 11 studies were included in the review. Results Qualitative analysis showed an increase risk of mortality with increased severity of injury, and in the operative group compared to non-operative group. All patients who were haemodynamically unstable underwent immediate operative management, whereas the management strategy for patients with haemodynamic stability differed between the studies and depended on either the grade of injury, presence of other organ injury, or failure of initial management strategy. Conclusions This systematic review largely reaffirmed accepted practice in determining operative versus non-operative treatment for blunt pancreatic injury. Larger institutional analyses are required to add strength to the evidence supporting non-operative management for grade III or IV injuries with appropriate monitoring and subsequent intervention if required.

Imaging of Blunt Pancreatic Trauma: A Systematic Review

2020 ◽  
Vol 71 (3) ◽  
pp. 344-351 ◽  
Author(s):  
Devang Odedra ◽  
Vincent M. Mellnick ◽  
Michael N. Patlas
Keyword(s):  
Systematic Review ◽  
Keyword Search ◽  
Pancreatic Injury ◽  
Imaging Modalities ◽  
Primary Study ◽  
Separate Analysis ◽  
Pancreatic Trauma ◽  
Study Objective ◽  
Large Variability ◽  
Blunt Pancreatic Trauma

Purpose: Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. Methods: Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. Results: After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. Conclusion: There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.

Operative versus non-operative management of blunt pancreatic trauma: A systematic review

Trauma ◽  
2018 ◽  
Vol 21 (4) ◽  
pp. 252-258
Author(s):  
David SC Soon ◽  
Yit J Leang ◽  
Charles HC Pilgrim
Keyword(s):  
Systematic Review ◽  
Operative Management ◽  
Low Grade ◽  
Lower Grade ◽  
Splenic Trauma ◽  
Pancreatic Trauma ◽  
Pancreatic Injuries ◽  
Combining Data ◽  
Blunt Pancreatic Trauma ◽  
Non Operative Management

Introduction Motor vehicle crashes are common causes of blunt abdominal trauma in the 21st century. While splenic trauma occurs very frequently and thus there is a well-established treatment paradigm, traumatic pancreatic injuries are relatively infrequent, occurring in only 3–5% of traumas. This low incidence means physicians have reduced experience with this condition and there is still ongoing debate with regards to the best practice in managing pancreatic trauma. During severe trauma, the pancreas can be injured as a consequence of blunt and penetrating injury. This has an estimated mortality rate ranging from 9 to 34%. Methods A systematic review was performed using three scientific databases: Embase, Medline and Cochrane and in-line with the PRISMA statement. We included only articles published in English, available as full text and describing only adults. Keywords included: pancrea*, trauma, blunt, operative management and non-operative management. Results Three studies were found that directly compared operative versus non-operative management in blunt pancreatic trauma. Length of stay, mortality and rate of re-intervention were lower in the non-operative group compared to the operative group. However, the average grade of pancreatic injury was lower in the non-operative group compared to the operative group. Discussion Our results revealed that patients who undergo non-operative management tend to have lower grade of injuries and patients with higher grade of injury tend to be managed in an operative fashion. This could be likely due to the fact that higher grade of pancreatic injuries is often accompanied by other injuries such as hollow viscus injury and therefore require operative intervention. Conclusion Non-operative management is a safe approach for low-grade blunt pancreatic trauma without ductal injuries. However, more evidence is required to improve our understanding and treatment plans. We suggest a large international multicentre study combining data from multiple international trauma centres to collect adequate data.

scholarly journals Blunt Pancreatic Injury in Major Trauma: Decision-Making between Nonoperative and Operative Treatment

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Christopher Ull ◽  
Sebastian Bensch ◽  
Thomas Armin Schildhauer ◽  
Justyna Swol
Keyword(s):  
Decision Making ◽  
Motor Vehicle ◽  
Sports Injuries ◽  
Exploratory Laparotomy ◽  
Pancreatic Injury ◽  
Initial Therapy ◽  
Complete Healing ◽  
Organ Injury ◽  
Pancreatic Trauma ◽  
Poor Outcomes

Blunt trauma injuries to the pancreas are rare but are associated with significant overall mortality and a high complication rate. Motor vehicle collisions are the leading cause of blunt pancreatic trauma, followed by falls, and sports injuries. We discuss the decision-making process used during the clinical courses of 3 patients with life-threatening blunt pancreatic injuries caused by traumatic falls. We also discuss the utility of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS), which provides a system for grading pancreatic trauma. Retrospectively, the cases reviewed were classified as AAST-OIS grade II, III, and IV in each one patient. Although the nonoperative approach was initially preferred, surgery was required in each case due to pseudocyst formation, pancreatic necrosis, and posttraumatic pancreatitis. In each case, complete healing was achieved through exploratory laparotomy with extensive lavage and placement of abdominal drains for several weeks postoperatively. These cases show that nonoperative management of pancreatic ductal trauma results in poor outcomes when initial therapy is less than optimal.

scholarly journals Uždaras izoliuotas ketvirto laipsnio kasos sužalojimas: klinikinis atvejis

2008 ◽  
Vol 6 (1) ◽  
pp. 0-0
Author(s):  
Tomas Vaitoška ◽  
Lina Praleikienė ◽  
Juozas Stanaitis ◽  
Raimundas Lunevičius
Keyword(s):  
Case Report ◽  
Surgical Intervention ◽  
Pancreatic Injury ◽  
Distal Segment ◽  
Care Hospital ◽  
Pancreatic Trauma ◽  
Rare Type ◽  
Blunt Pancreatic Trauma ◽  
Vilnius University ◽  
Surgery Center

Tomas Vaitoška, Lina Praleikienė, Juozas Stanaitis, Raimundas LunevičiusVilniaus universiteto Gastroenterologijos, nefrourologijos ir chirurgijosklinikos Bendrosios chirurgijos centras, Vilniaus universitetinėgreitosios pagalbos ligoninė, Šiltnamių g. 29, LT-04130 VilniusEl paštas: [email protected] Įvadas / tikslas Uždaras izoliuotas IV laipsnio kasos sužalojimas yra retas net specializuotose skubią pagalbą dėl ūminių ligų ir traumų teikiančiose ligoninėse. Straipsnio tikslas – aprašyti tokį kasos sužalojimą patyrusio ligonio chirurginio gydymo taktikos, kai atliekama pankreatojejunostomija, variantą. Klinikinis atvejis Dėl viršutinės pilvo dalies potrauminio progresuojančio peritonito 33 metų stabilios hemodinamikos vyrui atlikta viršutinė vidurinė laparotomija. Operacijos metu nustatyta peripankreatinė hematoma ir jos priežastis – izoliuotas visiškas skersinis kasos plyšimas ties viršutinėmis pasaito kraujagyslėmis. Proksimalinis sužalotos kasos galas užsiūtas dviejų aukštų pavienėmis siūlėmis. Distalinė kasos dalis susiūta su tuščiąja žarna Roux-en-Y būdu, t. y. suformuota pankreatojejunostoma. Pilvo ertmė drenuota keturiais drenais. Pooperacinių komplikacijų nebuvo. Išvada Roux-en-Y būdu atlikta pankreatojejunostomija yra veiksminga operacija gydant neseniai patirtą uždarą izoliuotą IV laipsnio kasos sužalojimą. Pagrindiniai žodžiai: uždara kasos trauma, pankreatojejunostomija Blunt isolated grade IV injury of pancreas: a case report Tomas Vaitoška, Lina Praleikienė, Juozas Stanaitis, Raimundas LunevičiusVilnius University, General Surgery Center of Clinic of Gastroenterology,Nephrourology and Surgery, Vilnius University Emergency Hospital,Šiltnamių str. 29, LT-04130 Vilnius, LithuaniaE-mail: [email protected] Background / objective A blunt isolated grade IV pancreatic injury is a rare type of trauma even for a specialized emergency care hospital. The purpose of the article is to describe the surgical treatment of pancreatic trauma of this type when Roux-en-Y pancreatojejunostomy had been performed. Case report A male patient was hospitalized due to blunt abdominal trauma. The progress of peritonitis determined the surgical intervention. Laparotomy was performed, and grade IV traumatic laesion of the pancreas was confirmed. The proximal edge of the ruptured pancreas was sutured, and Roux-en-Y pancreatojejunostomy was performed for the distal segment of the pancreas. There were no postoperative complications. Conclusion Roux-en-Y pancreatojejunostomy is an efective operation in case of blunt isolated grade IV pancreatic injury. Keywords: blunt pancreatic trauma, pancreatojejunostomy

Blunt Pancreatic Trauma in Children: A Systematic Review and Meta-Analysis of Operative vs Nonoperative Management

2017 ◽  
Vol 225 (4) ◽  
pp. e134
Author(s):  
Laura F. Goodman ◽  
Nicholas A. Generous ◽  
Paula L. Johns ◽  
Tarek Sawas ◽  
Alana L. Beres
Keyword(s):  
Systematic Review ◽  
Nonoperative Management ◽  
Meta Analysis ◽  
Pancreatic Trauma ◽  
Blunt Pancreatic Trauma

scholarly journals Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

2016 ◽  
Vol 10 ◽  
pp. 103-109 ◽  
Author(s):  
Suman B Koganti ◽  
Ravikanth Kongara ◽  
Sateesh Boddepalli ◽  
Naushad Shaik Mohammad ◽  
Venumadhav Thumma ◽  
...  
Keyword(s):  
Operative Management ◽  
Pancreatic Trauma ◽  
Blunt Pancreatic Trauma ◽  
Non Operative Management ◽  
Grade Iii

scholarly journals Blunt pancreatic trauma in children: a systematic review

HPB ◽  
2016 ◽  
Vol 18 ◽  
pp. e397
Author(s):  
E.Y. Koh ◽  
D. van Poll ◽  
J.C. Goslings ◽  
E.A. Rauws ◽  
M.W. Oomen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pancreatic Trauma ◽  
Blunt Pancreatic Trauma

scholarly journals Pancreatic trauma

2013 ◽  
Vol 95 (4) ◽  
pp. 241-245 ◽  
Author(s):  
R Lahiri ◽  
S Bhattacharya
Keyword(s):  
Prognostic Factor ◽  
Pancreatic Duct ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Pancreatic Trauma ◽  
Important Prognostic Factor ◽  
Pancreatic Duct Disruption ◽  
Upper Abdominal ◽  
High Index Of Suspicion ◽  
Duct Disruption

Introduction Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. Methods A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: ‘pancreatic trauma’, ‘pancreatic duct injury’, ‘radiology AND pancreas injury’, ‘diagnosis of pancreatic trauma’, and ‘management AND surgery’. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. Results Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with non-specific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. Conclusions The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases, experienced HPB surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery.

scholarly journals Non Operative Management of Blunt Pancreatic Trauma

HPB ◽  
2019 ◽  
Vol 21 ◽  
pp. S449-S450
Author(s):  
Dinesh Kumar Vadioaloo ◽  
Yu Hang Wai ◽  
Jasjit Singh Nijhar ◽  
Leow Voon Meng ◽  
Manisekar Subramaniam
Keyword(s):  
Operative Management ◽  
Pancreatic Trauma ◽  
Blunt Pancreatic Trauma ◽  
Non Operative Management
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