scholarly journals Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Federico Coccolini ◽  
◽  
Leslie Kobayashi ◽  
Yoram Kluger ◽  
Ernest E. Moore ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Biliary Tree ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
Anatomical Location ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Management Guidelines ◽  
Pancreatic Injuries ◽  
Extrahepatic Biliary Tree

AbstractDuodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

scholarly journals Surgical management of traumatic pancreatic injuries and their consequences.

2020 ◽  
Vol 7 (11) ◽  
pp. 3555
Author(s):  
Ashraf Mohammad El-badry ◽  
Mohamed Mahmoud Ali
Keyword(s):  
Surgical Management ◽  
Damage Control ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
University Hospital ◽  
Pancreatic Trauma ◽  
Surgical Interventions ◽  
Pancreatic Injuries ◽  
Group A ◽  
Group B

Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.

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

scholarly journals The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

2020 ◽  
Vol 11 (3) ◽  
pp. 3691-3698
Author(s):  
Adel Shaker Al Tamimi ◽  
Raafa Jawad Kadhm
Keyword(s):  
Abdominal Trauma ◽  
Traffic Accidents ◽  
Road Traffic ◽  
Pancreatic Injury ◽  
Surgical Approaches ◽  
Trauma Patients ◽  
Penetrating Abdominal Trauma ◽  
Surgical Department ◽  
Pancreatic Injuries ◽  
Control Study

The pancreas is a long J-shaped, soft, lobulated retroperitoneal organ. Pancreatic injury is relatively uncommon, occurring in 0.2–2 % of all trauma patients and 3–12 % of patients with abdominal injury. All traumatic pancreatic injuries are associated with significant morbidity with an overall rate of morbidity nearing 40%, higher grade pancreatic injuries are associated with higher rates of morbidity and mortality . To evaluate of surgical management of blunt and penetrating pancreatic trauma. During the period from January 2015 to September 2018, thirty patients with blunt and penetrating abdominal trauma were managed in emergency surgical department in Al-Diwaniya Teaching Hospital and assigned in prospective a case control study. Patients with proved associated pancreatic injury (regardless of the degree) at the time of laparotomy were included in the study . The mean age of patients was 34.4 year (17- 57 years) among them there was 25 male (83.3 %) and 5 females (16. 7% The overall mortality rate is 20% (6 patients). The predominant mechanism of injury was penetrating 24 patients (80%) from gunshots and 6 patients with blunt abdominal trauma resulted from road traffic accidents). Pancreatic injury is infrequent in abdominal trauma. Its frequency is little different between blunt and penetrating abdominal trauma.

scholarly journals Surgical treatment in hepatic trauma: factors associated with hospitalization time

2021 ◽  
Vol 48 ◽  
Author(s):  
PAULA DE OLIVEIRA TRINTINALHA ◽  
EMANUELLA ROBERNA INÁ CIRINO ◽  
RENATA FERNANDA RAMOS MARCANTE ◽  
GABRIEL RAMOS JABUR ◽  
PATRÍCIA LONGHI BUSO
Keyword(s):  
Surgical Treatment ◽  
Hospital Stay ◽  
Penetrating Trauma ◽  
Length Of Hospital Stay ◽  
Hemodynamic Instability ◽  
Liver Trauma ◽  
University Hospital ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Firearm Injury

ABSTRACT Objective: the aim of this study was to identify associated factors with the increased length of hospital stay for patients undergoing surgical treatment for liver trauma, and predictors of mortality as well as the epidemiology of this trauma. Methods: retrospective study of 191 patients admitted to the Cajuru University Hospital, a reference in the treatment of multiple trauma patients, between 2010 and 2017, with epidemiological, clinicopathological and therapeutic variables analyzed using the STATA version 15.0 program. Results: most of the included patients were men with a mean age of 29 years. Firearm injury represents the most common trauma mechanism. The right hepatic lobe was injured in 51.2% of the cases, and hepatorraphy was the most commonly used surgical correction. The length of hospital stay was an average of 11 (0-78) days and the length of stay in the intensive care unit was 5 (0-52) days. Predictors for longer hospital stay were the mechanisms of trauma, hemodynamic instability at admission, number of associated injuries, degree of liver damage and affected lobe, used surgical technique, presence of complications, need for reoperation and other surgical procedures. Mortality rate was 22.7%. Conclusions: the study corroborated the epidemiology reported by the literature. Greater severity of liver trauma and associated injuries characterize patients undergoing surgical treatment, who have increased hospital stay due to the penetrating trauma, hemodynamic instability, hepatic packaging, complications and reoperations.

Pelvic Fractures in Children

2006 ◽  
Vol 72 (10) ◽  
pp. 962-965 ◽  
Author(s):  
Janneth P. Momiy ◽  
John L. Clayton ◽  
Herman Villalba ◽  
Marilyn Cohen ◽  
Jonathan R. Hiatt ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hemodynamic Instability ◽  
Pelvic Fractures ◽  
Intensive Care Unit Care ◽  
Trauma Patients ◽  
Associated Injuries ◽  
The Past ◽  
Fractures In Children ◽  
Level I

Although rare, pelvic fractures in children have significant morbidity and mortality. No specific guidelines have been developed for the management of these injuries. We reviewed all trauma patients of age 16 years or younger with pelvic fractures treated at our Level I trauma center over the past 12 years. Of 1008 patients with pelvic fractures, 74 were children. Early hemodynamic instability was seen in 14 per cent of cases. Blood transfusions were required in 26 per cent of cases, angiography in 3 per cent of cases, operations for associated injuries in 46 per cent of cases, operative pelvic fracture fixation in 18 per cent of cases, and intensive care unit care in 58 per cent of cases. Mortality was 5 per cent, mostly from hemorrhage and multiple complex injuries. We conclude that pelvic fractures in children are associated with a high frequency of pelvic bleeding and associated injuries that often require operative interventions and intensive care unit care.

Pediatric Trauma Patients with Temporal Bone Fractures Are at Risk for Multiple Cranial CT Scans

2020 ◽  
Author(s):  
Joshua Ewy ◽  
Martin Piazza ◽  
Brian Thorp ◽  
Michael Phillips ◽  
Carolyn Quinsey
Keyword(s):  
At Risk ◽  
Temporal Bone ◽  
Bone Fractures ◽  
Pediatric Trauma ◽  
Ct Scans ◽  
Trauma Patients ◽  
Cranial Ct

The Frequency of Random Findings on Abdominal / Pelvis Computed Tomography in Pediatric Trauma Patients

2020 ◽  
Vol 16 ◽  
Author(s):  
Betül Tiryaki Baştuğ
Keyword(s):  
Computed Tomography ◽  
Incidental Findings ◽  
Pediatric Population ◽  
Pediatric Trauma ◽  
Trauma Patients ◽  
Injured Child ◽  
Level 3 ◽  
Male Patients ◽  
Clinically Significant ◽  
Discharge Summaries

Aims: In this study, we aimed to find the percentage of random pathologies and abdominopelvic region anomalies that are not related to trauma in pediatric patients. Background: An abdominal assessment of an injured child usually involves computed tomography imaging of the abdomen and pelvis (CTAP) to determine the presence and size of injuries. Imaging may accidentally reveal irrelevant findings. Objectives: Although the literature in adults has reviewed the frequency of discovering these random findings, few studies have been identified in the pediatric population. Methods: Data on 142( 38 female, 104 male) patients who underwent CTAP during their trauma evaluation between January 2019 and January 2020 dates were obtained from our level 3 pediatric trauma center trauma records. The records and CTAP images were examined retrospectively for extra traumatic pathologies and anomalies. Results: 67 patients (47%) had 81 incidental findings. There were 17 clinically significant random findings. No potential tumors were found in this population. Conclusion: Pediatric trauma CTAP reveals random findings. For further evaluation, incidental findings should be indicated in the discharge summaries.

Injury Patterns in Pediatric Facial Fractures Unique to an Urban Environment

2021 ◽  
Author(s):  
Anthony P. Sclafani ◽  
Matthew Scott Sclafani ◽  
Sallie Long ◽  
Tasher Losenegger ◽  
Daniel Spielman ◽  
...  
Keyword(s):  
Urban Environment ◽  
Older Patients ◽  
High Energy ◽  
Urban Setting ◽  
Cranial Bone ◽  
Csf Leak ◽  
Facial Trauma ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Facial Fractures

AbstractThis study aimed to define better the clinical presentation, fracture patterns, and features predictive of associated injuries and need for surgery in pediatric facial trauma patients in an urban setting. Charts of patients 18 years or younger with International Classification of Disease 9th and 10th revision (ICD-9/ICD-10) codes specific for facial fractures (excluding isolated nasal fractures) at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017 were retrospectively reviewed. Of 204 patients, most were referred to the emergency department by a physician's office or self-presented. Children (age 0–6 years) were most likely to have been injured by falls, while more patients 7 to 12 years and 13 to 18 years were injured during sporting activities (p < 0.0001). Roughly half (50.5%) of the patients had a single fracture, and the likelihood of surgery increased with greater numbers of fractures. Older patients with either orbital or mandibular fractures were more likely to undergo surgery than younger ones (p = 0.0048 and p = 0.0053, respectively). Cranial bone fractures, CSF leaks, and intracranial injuries were more common in younger patients (p < 0.0001) than older patients and were more likely after high energy injuries; however, 16.2% of patients sustaining low energy injuries also sustained cranial bone, CSF leak, or intracranial injury. In an urban environment, significant pediatric facial fractures and associated injuries may occur after nonclassic low kinetic energy traumatic events. The age of the patient impacts both the injuries sustained and the treatment rendered. It is essential to maintain a high index of suspicion for associated injuries in all pediatric facial trauma patients.

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