Primary Repair of Traumatic Complete Pancreatic Rupture

Isolated pancreatic injury with transection of the pancreatic duct is generally treated with pancreatic resection, but the optimal management is not based on high-level evidence. Herein, we report a case of primary repair of complete rupture of the pancreas and pancreatic duct after a blunt abdominal trauma and a review of the literature. A 33-year-old patient had an isolated pancreatic injury after blunt abdominal trauma. At laparotomy, an even transection was found with minimal necrosis and tissue loss and an end-to-end anastomosis of the duct and the parenchyma with omental patch was performed. Patient’s postoperative course was complicated by a 6 cm pseudocyst and a low output pancreatic fistula which did not require any intervention and were self-limited. In the literature, 17 cases with primary repair of similar grade IV pancreatic injuries have been reported. Postoperative complications included mostly fistulas and pseudocysts.

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Tu1989 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) WITH PANCREATIC DUCT (PD) STENT PLACEMENT FOR THE MANAGEMENT OF GRADE 3 OR HIGHER PANCREATIC INJURIES IN CHILDREN WITH BLUNT ABDOMINAL TRAUMA

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2018.04.2314 ◽

2018 ◽

Vol 87 (6) ◽

pp. AB611 ◽

Cited By ~ 1

Author(s):

Rehan Naseemuddin ◽

Chris S. Fritzen ◽

Alvin J. Freeman ◽

Steven Keilin ◽

Qiang Cai ◽

...

Keyword(s):

Pancreatic Duct ◽

Endoscopic Retrograde Cholangiopancreatography ◽

Abdominal Trauma ◽

Stent Placement ◽

Blunt Abdominal Trauma ◽

Endoscopic Retrograde ◽

Pancreatic Injuries ◽

Grade 3

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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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Isolated pancreatic injury following blunt abdominal trauma in a child

Indian Journal of Critical Care Medicine ◽

10.4103/0972-5229.33393 ◽

2007 ◽

Vol 11 (2) ◽

pp. 96-98 ◽

Cited By ~ 4

Author(s):

Sandeep Jain ◽

Parag Telang ◽

M.A. Joshi ◽

Sandhya Prabhakar

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Pancreatic Injury ◽

Isolated Pancreatic Injury

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Conservative surgery for pancreatic neck transection

Polish Journal of Surgery ◽

10.1515/pjs-2015-0061 ◽

2015 ◽

Vol 87 (6) ◽

Cited By ~ 4

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.

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Management of isolated high grade blunt pancreatic injury; case report on lesser aggressive approach

International Surgery Journal ◽

10.18203/2349-2902.isj20191910 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1789

Author(s):

Manjit Singh ◽

Mritunjay Sarawagi ◽

Anjay Kumar ◽

Uday Kumar

Keyword(s):

Case Report ◽

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Pancreatic Injury ◽

High Index ◽

High Grade ◽

Rare Entity ◽

Aggressive Approach ◽

Isolated Pancreatic Injury ◽

High Index Of Suspicion

Isolated high grade pancreatic injury is rare after blunt abdominal trauma. It is a rare entity to appreciate intra-operatively and a high index of suspicion should always be kept in mind to reach the diagnosis. We are presenting our experience of four cases with moderate to high grade isolated pancreatic injury which were managed in a lesser aggressive approach and had an uneventful outcome.

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Pancreatic Injury from Blunt Abdominal Trauma in Childhood

Acta Chirurgica Belgica ◽

10.1080/00015458.2005.11679717 ◽

2005 ◽

Vol 105 (3) ◽

pp. 283-286 ◽

Cited By ~ 12

Author(s):

V. Ruszinkó ◽

P. Willner ◽

A. Oláh

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Pancreatic Injury

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Operative Intervention for Complete Pancreatic Transection in Children Sustaining Blunt Abdominal Trauma: Revisiting an Organ Salvage Technique

The American Surgeon ◽

10.1177/000313481107700523 ◽

2011 ◽

Vol 77 (5) ◽

pp. 612-620 ◽

Cited By ~ 7

Author(s):

Matthew J. Borkon ◽

Stephen E. Morrow ◽

Elizabeth A. Koehler ◽

Yu Shyr ◽

Melissa A. Hilmes ◽

...

Keyword(s):

Abdominal Trauma ◽

Blunt Abdominal Trauma ◽

Injury Severity ◽

Demographic Data ◽

Operative Management ◽

Pancreatic Injury ◽

Pancreatic Tissue ◽

Management Algorithm ◽

Lengths Of Stay ◽

Pancreatic Transection

Complete pancreatic transection (CPT) in children is managed commonly with distal pancreatectomy (DP). Alternatively, Roux-en-Y distal pancreaticojejunostomy (RYPJ) may be performed to preserve pancreatic tissue. The purpose of this study was to review our experience using either procedure in the management of children sustaining CPT after blunt abdominal trauma. We retrospectively reviewed the records of all children admitted to our institution during the last 15 years who were confirmed at operation to have CPT after blunt mechanisms. Summary statistics of demographic data were performed to describe children receiving either RYPJ or DP. CPT occurred in 28 children: 15 had DP, 10 had RYPJ, and three had cystogastrostomy. RYPJ children, compared with DP, were younger (7.5 vs 12.3 years, P = 0.039) and sustained more grade IV pancreatic injuries (70% vs 14%, P = 0.01). DP patients were 5.63 times more likely to tolerate full enteral feeds ( P = 0.009). Nevertheless, when controlling for age, injury severity score, and pancreatic injury grade, procedure type did not statistically affect total and postoperative lengths of stay and postoperative complications. In the operative management algorithm of children sustaining CPT, DP may afford an earlier return to full enteral feeds. RYPJ seems otherwise equivalent to DP and preserves significant pancreatic glandular tissue and the spleen.

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