Novel Promising Technique for Traumatic Pancreatic Injury Management.

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.

Primary Repair of Traumatic Complete Pancreatic Rupture

2021 ◽  
pp. 000313482110385
Author(s):  
Maria Venianaki ◽  
Despoina Ierodiakonou ◽  
Evangelia Chryssou ◽  
Emmanuel Chrysos ◽  
Georgios Chalkiadakis ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Primary Repair ◽  
Pancreatic Injury ◽  
Tissue Loss ◽  
Omental Patch ◽  
Pancreatic Injuries ◽  
Isolated Pancreatic Injury ◽  
High Level

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.

scholarly journals Successful nonoperative management by endoscopic and percutaneous drainage for penetrating pancreatic duct injury: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Hiroki Kanno ◽  
Yusuke Hirakawa ◽  
Masafumi Yasunaga ◽  
Ryuta Midorikawa ◽  
Shinichi Taniwaki ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Percutaneous Drainage ◽  
Main Pancreatic Duct ◽  
Nonoperative Management ◽  
Pancreatic Head ◽  
Pancreatic Injury ◽  
High Grade ◽  
Pancreatic Trauma ◽  
Contrast Enhanced ◽  
Grade Iii

Abstract Background Pancreatic trauma is a rare condition with a wide presentation, ranging from hematoma or laceration without main pancreatic duct involvement, to massive destruction of the pancreatic head. The optimal diagnosis of pancreatic trauma and its management approaches are still under debate. The East Association of Surgery for Trauma (EAST) guidelines recommend operative management for high-grade pancreatic trauma; however, several reports have reported successful outcomes with nonoperative management (NOM) for grade III/IV pancreatic injuries. Herein, we report a case of grade IV pancreatic injury that was nonoperatively managed through endoscopic and percutaneous drainage. Case presentation A 47-year-old Japanese man was stabbed in the back with a knife; upon blood examination, both serum amylase and lipase levels were within normal limits. Contrast-enhanced computed tomography (CT) showed extravasation of the contrast medium around the pancreatic head and a hematoma behind the pancreas. Abdominal arterial angiography revealed a pseudo aneurysm in the inferior pancreatoduodenal artery, as well as extravasation of the contrast medium in that artery; coil embolization was thus performed. On day 12, CT revealed a wedge-shaped, low-density area in the pancreatic head, as well as consecutive pseudocysts behind the pancreas; thereafter, percutaneous drainage was performed via the stab wound. On day 22, contrast radiography through the percutaneous drain revealed the proximal and distal parts of the main pancreatic duct. The injury was thus diagnosed as a grade IV pancreatic injury based on the American Association for the Surgery of Trauma guidelines. On day 26, an endoscopic nasopancreatic drainage tube was inserted across the disruption; on day 38, contrast-enhanced CT showed a marked reduction in the fluid collection. Finally, on day 61, the patient was discharged. Conclusions Although the EAST guidelines recommend operative treatment for high-grade pancreatic trauma, NOM with appropriate drainage by endoscopic and/or percutaneous approaches may be a promising treatment for grade III or IV trauma.

scholarly journals Pancreatic trauma: proposal for management algorithm

2020 ◽  
Author(s):  
Daisuke Hashimoto ◽  
Tomohisa Yamamoto ◽  
So Yamaki ◽  
Kazuhito Sakuramoto ◽  
Rintaro Yui ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Mortality Rate ◽  
Pancreatic Duct ◽  
Conservative Management ◽  
Main Pancreatic Duct ◽  
Surgical Techniques ◽  
Postoperative Mortality ◽  
Pancreatic Trauma ◽  
Endoscopic Nasopancreatic Drainage ◽  
Nasopancreatic Drainage

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.

scholarly journals A RARE CASE OF PANCREATIC INJURY WITH TRANSECTION OF MAIN PANCREATIC DUCT MANAGED CONSERVATIVELY

2018 ◽  
Vol 4 (4) ◽  
pp. 286-288
Author(s):  
Ashutosh Ghuge . ◽  
Rajiv Sonarkar . ◽  
Bapuji S Gedam . ◽  
Giriraj Gajendra
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Rare Case ◽  
Pancreatic Injury

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.

scholarly journals Step up approach for the management of late presentation of pancreatic trauma patients

2020 ◽  
Vol 7 (4) ◽  
pp. 1065
Author(s):  
Shabi Ahmad ◽  
Vikram Singh ◽  
Vinod Kumar Pandey ◽  
Shirish Kumar ◽  
Tabrej Alam ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Late Presentation ◽  
Trauma Patients ◽  
Delayed Presentation ◽  
Pancreatic Trauma ◽  
Delay In Diagnosis ◽  
Second Stage ◽  
Remnant Pancreas ◽  
Pancreatic Injuries ◽  
Time Of Admission

Background: Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities and these injuries are often overlooked in cases with extensive multi-organ trauma. Our study was conducted to evaluate the outcome of a step-up approach in the management of pancreatic trauma patients with late presentation.Methods: The study included 15 patients who presented with grade III AAST delayed presentation of pancreatic trauma from September 2017 to 2019. In our step-up approach 2 staged procedure was done, firstly laparotomy with necrosectomy along with closure of proximal pancreatic duct with external drainage of pancreatic duct, in second stage Roux-en-Y pancreaticojejunostomy was done to drain the remnant pancreas as a definitive procedure 3 to 6 months after initial procedure.Results: In our study, blunt trauma abdomen (83.30%) (n=10) was the most common mode of injury. The main reason for delay in diagnosis of pancreatic trauma was delayed presentation of patient (83.3%) (n=10). Total of 4 patients were admitted to intensive care unit (ICU) at the time of admission. 10 patients underwent both the stages of step up approach management among which one patient had pancreatic fistula as a complication (n=1) (10%) and one patient had post-operative abscess as a complication (n=1) (10%). No mortality was noted in our study.Conclusions: The step-up approach discussed above proves to be beneficial towards management of patients with delayed presentation of pancreatic trauma in our setting.

scholarly journals Pancreas Preserving Operation for Type IIIa Pancreatic Injury with Rupture of the Main Pancreatic Duct. Report of a Case.

2001 ◽  
Vol 62 (7) ◽  
pp. 1741-1744
Author(s):  
Takeshi SHIMIZU ◽  
Seishiro INABA ◽  
Hiroshi KOYAMA ◽  
Atsuhiro OGINO ◽  
Masashi NAKATA ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Main Pancreatic Duct ◽  
Pancreatic Injury ◽  
Type Iiia
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