scholarly journals Management of Pancreatic Trauma In Urban India: A Multicenter Study

2021 ◽  
Author(s):  
Devi Bavishi ◽  
Monty Khajanchi ◽  
Ramlal Prajapati ◽  
Anita Gadgil ◽  
Bhakti Sarang ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Associated Injuries ◽  
Pancreatic Trauma ◽  
Level Of Evidence ◽  
Mortality And Morbidity ◽  
Care Outcomes ◽  
Multicenter Prospective Observational Study

Abstract Background: Pancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1–12% of patients with penetrating trauma. The mortality and morbidity rates range from 9-34% and 30-60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India.Methods: We analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’.Results: Of the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), bowel (14) and spleen (13) were the most common associated injuries.Conclusion: Conservative management was as common as operative management in patients with pancreatic injuries. Most (80%) grade III/IV underwent operative treatment. Many patients (82%) had associated injuries. Level of evidence: III

scholarly journals Management of Pancreatic Trauma in Urban India: A Multicenter Study

2021 ◽  
Author(s):  
Devi Bavishi ◽  
Monty Khajanchi ◽  
Ramlal Prajapati ◽  
Anita Gadgil ◽  
Bhakti Sarang ◽  
...  
Keyword(s):  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Associated Injuries ◽  
Pancreatic Trauma ◽  
Level Of Evidence ◽  
Mortality And Morbidity ◽  
Care Outcomes ◽  
Multicenter Prospective Observational Study

Abstract BackgroundPancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1–12% of patients with penetrating trauma. The mortality and morbidity rates range from 9-34% and 30-60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India.MethodsWe analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study ‘Towards Improved Trauma Care Outcomes (TITCO)’.ResultsOf the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), bowel (14) and spleen (13) were the most common associated injuries.ConclusionConservative management was as common as operative management in patients with pancreatic injuries. Most (80%) grade III/IV underwent operative treatment. Many patients (82%) had associated injuries. Level of evidence: III

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

2011 ◽  
Vol 77 (5) ◽  
pp. 612-620 ◽  
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.

scholarly journals Imaging of Pancreatic Trauma—A Clinical Scenario-Based Approach

2020 ◽  
Vol 3 (01) ◽  
pp. 028-034
Author(s):  
Naren Hemachandran ◽  
Shivanand Gamanagatti
Keyword(s):  
Magnetic Resonance ◽  
Abdominal Trauma ◽  
Clinical Signs ◽  
Vascular Complications ◽  
Pancreatic Injury ◽  
High Morbidity ◽  
Pancreatic Trauma ◽  
Clinical Scenarios ◽  
Management Of Complications ◽  
Secondary Signs

AbstractPancreatic injury, although uncommon in the setting of abdominal trauma, is associated with high morbidity and mortality. While the clinical signs are nonspecific, the imaging signs can be very subtle in the early stages leading to missed injuries that present later as complications. Contrast-enhanced computed tomography (CT) is the main workhorse and initial imaging modality in the setting of abdominal trauma, while magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography is used as a problem-solving tool in pancreatic trauma.This article provides a review of the imaging of pancreatic trauma and has been organized into common clinical scenarios–Suspected pancreatic injury with normal-appearing pancreas on CT; definite pancreatic injury on CT, late presentation or complication in a patient with pancreatic injury. The role of the radiologist in each scenario is described as follows: to identify subtle secondary signs of injury and resort to MRI or a repeat imaging wherever necessary in a suspected pancreatic injury with normal-appearing pancreas on CT (Scenario 1); to look for primary/hard signs, grade the injury according to American Association of Surgery for Trauma Organ Injury Scale, and utilize MRI if necessary to ascertain the presence of ductal injury when a definite pancreatic injury is seen on CT (Scenario 2); and to diagnose various complications and help in the management of complications such as draining collections or vascular complications like pseudoaneurysms (Scenario 3).Radiologists should be aware of the primary and secondary signs of pancreatic injury so as to enable prompt diagnosis and further management. Radiologists play an important role not only in the diagnosis of pancreatic injuries but also in the management of certain complications.

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.

Outcome and management strategy of traumatic liver injury in a tertiary hospital in Bangladesh

2020 ◽  
Vol 22 (1) ◽  
pp. 36-42
Author(s):  
HA Nazmul Hakim ◽  
Kazi Mazharul Islam ◽  
Md Aminul Islam ◽  
ANM Nure Azam ◽  
Md Tuhin Talukder ◽  
...  
Keyword(s):  
Liver Injury ◽  
Hepatic Injury ◽  
Surgical Intervention ◽  
Road Traffic ◽  
Demographic Data ◽  
Penetrating Trauma ◽  
Associated Injuries ◽  
Concomitant Injuries ◽  
College Hospital ◽  
Mortality And Morbidity

Background: Liver remains the second most common injured organ in both blunt and penetrating trauma of the abdomen. Management of blunt or penetrating injury to the liver remains a significant challenge to trauma surgeons. Unstable patients require immediate laparotomy. Selective patients can be managed without surgery and with careful monitoring. Mortality is mainly due to damage to major hepatic blood vessels, massive parenchymal and biliary injury. Associated non-hepatic injuries contribute greatly to the overall mortality. With improved understanding of the major causes of mortality from hepatic injury, adequate resuscitation, well planned surgical intervention and better intensive care facilities have decreased mortality and morbidity Objectives: Performed to assess incidence, mechanisms, management and outcome of traumatic liver injury. Methods: This prospective study was performed in Dhaka Medical College Hospital between January 2013 to December 2014. Sixty patients with hepatic injury were included in the study. Data collected in data collection sheet regarding demographic data, severity of liver injury, hemodynamic status on admission, investigations reports, concomitant injuries, management scheme, and outcome of patients which were then analyzed. Results: There were 39 male and 21 female patients with a mean age of 31.3 (SD=15.4) years. Road traffic accident was the most common injury mechanism (71%). 20 patients (33%) were in shock at the time of admission. 48 patients (80%) with liver injury had associated injuries of other organs. Majority of the patients (41%) were found with grade Ill injury. 50 patients (83%) needed surgical interventions. Most common (16%) complication was wound infection. 3 patients (5%) died in this series. 5 patients (8%) developed liver abscess on subsequent follow up. Conclusion: Most of the trauma victims are young and in the active state of life. Prompt resuscitative measures, assessment of extend of hepatic injury and associated injuries, well justified surgical intervention along with critical care support can contribute greatly to the survival of victims of hepatic injury. Journal of Surgical Sciences (2018) Vol. 22 (1): 36-42

Tompa pancreastrauma diagnózisa és kezelése

2018 ◽  
Vol 159 (2) ◽  
pp. 43-52 ◽  
Author(s):  
Dániel Kollár ◽  
F. Tamás Molnár ◽  
Péter Zsoldos ◽  
Attila Oláh
Keyword(s):  
Conservative Treatment ◽  
Pancreatic Duct ◽  
Case Reports ◽  
Penetrating Trauma ◽  
Pancreatic Injury ◽  
Evidence Based ◽  
Extensive Literature ◽  
Pancreatic Trauma ◽  
Expert Opinions ◽  
Patient Groups

Abstract: The management of thoracic and abdominal organ injuries has very thorough and extensive literature, including evidence-based protocols. Pancreatic trauma stands as an exception. Blunt or penetrating trauma of the pancreas is rather rare (less than 2% of all trauma cases, approximately 3–12% of all abdominal trauma), leading to the lack of high-level evidences regarding its treatment. Damage of the pancreas parenchyma can cause substantial morbidity and mortality, therefore it is essential to separate cases where conservative treatment suffices from those that need surgical approach. This study aims to review the conclusions of relevant articles of the past decades concerning the management of both adult and childhood pancreatic trauma. Classifications and their reliability are revised. We enlist scaling systems that can help in making decision whether to operate or to treat conservatively, from physical examination to diagnostic measures and complications. To date, the treatment principles of pancreatic trauma are not based either on prospective or on randomised trials. The database search of studies retrieved only retrospective and/or small case cohorts, case reports and expert opinions (levels 4 and 5 of evidence). However, it is a generally accepted conviction that the damage of the main pancreatic duct determines if the pancreatic injury is of low or high grade. Available classifications are based on the same principle. Conservative treatment is feasible given that the patient is hemodinamically stable and the pancreatic duct is unimpaired. If duct lesion is discovered, adult cases are to be treated with minimally invasive (percutaneous or endoscopic) measures or surgically (including reconstruction, resection and drainage). The management of childhood injuries has controversial literature. Many arguments can be enumerated on the operative as also on the non-operative approach, this confusion is to be clarified in the future. The highest morbidity rates are derived from the late diagnosis of the pancreatic duct, while increased mortality is seen in the polytrauma patient groups. Levels 1–2 evidence-based recommendations are needed, but planning of strong trials is critically limited due to the small number of cases and the heterogeneity of the relevant patient groups. Orv Hetil. 2018; 159(2): 43–52.

scholarly journals Management of pediatric blunt abdominal trauma: تدبير رضوح البطن الكليلة عند الأطفال

2021 ◽  
Vol 5 (4) ◽  
pp. 27-20
Author(s):  
Wassem Ameer Shater, Mohammad Ali Nasser, Ali Mohammad Allou Wassem Ameer Shater, Mohammad Ali Nasser, Ali Mohammad Allou
Keyword(s):  
Operative Treatment ◽  
Abdominal Trauma ◽  
Blunt Abdominal Trauma ◽  
Surgical Intervention ◽  
Operative Management ◽  
Pancreatic Injury ◽  
University Hospital ◽  
Hospital Length Of Stay ◽  
Abdominal Injuries ◽  
Non Operative Management

Aim of study: Evaluating a non- operative treatment of pediatric blunt abdominal trauma and avoiding unnecessary surgical intervention in Tishreen University Hospital. Methods: During years (2016- 2020) a retroprospective study was conducted on 62 children who had isolated blunt abdominal trauma or associated with other injuries, most of them were managed by non- operative treatment but some required surgical management. Results: Non- operative management of pediatric blunt abdominal injuries was applied for 59 patients, three patients required a surgical procedure, the spleen was the most organ exposed to injury (40) child, followed by liver (26) child, kidney (4) and (1) pancreatic injury. Non- operative management was successful in most solid organs injuries with grades 1, 2 and 3, but it failed in 5 grade splenic injury. one out of two hollow viscus injuries required surgical intervention. There were no statistical differences between the study groups in age, gender and injury mechanism. Hospital length of stay was significantly longer in patients who underwent a laparotomy (6) days compared to other non- operative patients (3) days, one complication occurred during non- operative management as pseudocyst after pancreatic injury, (4) patient died in the non- operative group due to hemodynamic instability and associated severe cerebral injuries. Conclusion: It is safe to treat most children with blunt abdominal injuries non- operatively if monitoring is adequate with hemodynamic stability.

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.

scholarly journals Descriptive Analysis Of Clinical Presentation And Management Of Pancreatic Trauma At A Level I Trauma Centre

2021 ◽  
Author(s):  
Hassan Al-Thani ◽  
Ahmed Faidh Ramzee ◽  
Ammar Al-Hassani ◽  
Gustav Strandvik ◽  
Ayman El-Menyar
Keyword(s):  
Hemorrhagic Shock ◽  
Descriptive Analysis ◽  
Young Male ◽  
Operative Management ◽  
Pancreatic Injury ◽  
Trauma Centre ◽  
Low Grade ◽  
Lower Grade ◽  
Pancreatic Trauma ◽  
Pancreatic Injuries

Background: We aimed to study the frequency, management, and outcomes of patients with blunt pancreatic trauma. Methods: We reviewed the medical records for all patients admitted with pancreatic injuries between 2011 and 2017 at the only level 1 trauma center in the country. Results: There were 71 patients admitted with pancreatic trauma (0.6% of trauma admissions and 3.4% of abdominal injury admissions) with a mean age of 31 years. Sixty-two patients had pancreatic injury grade I-II and 9 had grade III-IV. Thirty-eight percent had GCS <9 and 73% had ISS >16. The level of pancreatic enzymes was significantly proportional to the grade of injury. Over half of patients required a laparotomy, of them 12 patients had an intervention on the pancreas. Eight patients developed complications related to pancreatic injuries ranging from pancreatitis to pancreatico-cutaneous fistula while 35% developed hemorrhagic shock. Mortality was 31% and regardless of the grade of injury, the mortality was associated with high ISS, low GCS and presence of hemorrhagic shock. Conclusion: Pancreatic injuries following blunt trauma are rare and the injured subjects are usually young male. However, most injuries are of low-grade severity. This study shows that shock, higher ISS and lower GCS are associated with worse in-hospital out-comes. Non-operative management may suffice in patients with lower grade injuries, which may not be the case in patients with higher grade injuries unless carefully selected

scholarly journals Hepatic Trauma Interventions

2021 ◽  
Vol 38 (01) ◽  
pp. 096-0104
Author(s):  
Akshita S. Pillai ◽  
Girish Kumar ◽  
Anil K. Pillai
Keyword(s):  
Liver Injury ◽  
Cause Of Death ◽  
Abdominal Trauma ◽  
Penetrating Trauma ◽  
Liver Trauma ◽  
Solid Organ ◽  
Hepatic Trauma ◽  
Blunt Abdominal Injury ◽  
Large Size ◽  
Uncontrolled Bleeding

AbstractThe liver is the second most commonly involved solid organ (after spleen) to be injured in blunt abdominal trauma, but liver injury is the most common cause of death in such trauma. In patients with significant blunt abdominal injury, the liver is involved approximately 35 to 45% of the time. Its large size also makes it a vulnerable organ, commonly injured in penetrating trauma. Other than its position and size, the liver is surrounded by fragile parenchyma and its location under the diaphragm makes it vulnerable to shear forces during deceleration injuries. The liver is also a vascular organ made of large, thin-walled vessels with high blood flow. In severe hepatic trauma, hemorrhage is a common complication and uncontrolled bleeding is usually fatal. In fact, in patients with severe abdominal trauma, liver injury is the primary cause of death. This article reviews the clinical presentation of patients with liver injury, the grading system for such injuries that is most frequently used, and management of the patient with liver trauma.

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