Pseudocysts and recent closed pancreatic trauma

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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Management of pancreatic trauma in adult patients at tertiary care institute of Gujarat, India

Surgical Update: International Journal of Surgery and Orthopedics ◽

10.17511/ijoso.2020.i05.04 ◽

2020 ◽

Vol 6 (5) ◽

pp. 310-315

Author(s):

Dr. Krunal Chandana ◽

◽

Dr. Priyank Patel ◽

Keyword(s):

Road Traffic ◽

Demographic Data ◽

Tertiary Care ◽

Pancreatic Injury ◽

Solid Organ ◽

Pancreatic Trauma ◽

Tertiary Center ◽

Fall From Height ◽

Study Population ◽

Grade Ii

Background and Aim: Pancreatic trauma is rare compared to other solid organ injuries of theabdomen. These injuries are difficult to diagnose and pose a problem in treatment strategy. Thisretrospective study aims to report our tertiary center experience in the management of pancreatictrauma. Material and Methods: The present study is one and half year observational study of 30patients who underwent pancreatic trauma management in the Department of Surgery, tertiary careinstitute of Gujarat. Demographic data and baseline characteristics were recorded, including age,sex, medical co-morbidities, mechanism of pancreatic trauma, length of the hospital stay, andassociated extrapancreatic injuries. All patients underwent a CT scan for the diagnosis of pancreaticinjury. Grading of pancreatic trauma was carried out according to the American Association forsurgery for Trauma (AAST). Results: Road traffic accident (RTA) (n=20) was the leading cause ofpancreatic trauma in the study population followed by fall from height (n=7) and assault (n=3). Themajority of the study population had Grade III pancreatic injury (n=12) followed by Grade IV (n=8),Grade II (n=7), and Grade I (n=3) injuries. No patients had Grade V injury. Isolated pancreatictrauma was seen in 13 patients. Associated liver and spleen injury was seen in 15 patients. Renaltrauma was seen in 2 patients. The extra-abdominal injury was seen to be associated withpancreatic injury in 7 patients. Conclusion: Pancreatic trauma can be managed conservativelyirrespective of the grade of injury supported by radiological percutaneous drainage and pancreaticduct stenting in selective cases.

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