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

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

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.62.1741 ◽

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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Three cases of paediatric pancreatic injury involving the main pancreatic duct

Trauma Case Reports ◽

10.1016/j.tcr.2019.100253 ◽

2019 ◽

Vol 24 ◽

pp. 100253

Author(s):

Takeshi Omura ◽

Kenta Matsushita ◽

Miharu Arase ◽

Toshiyuki Yagi

Keyword(s):

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Pancreatic Injury

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CASE OF SUCCESSFUL CURE OF PROXIMAL TRANSECTION PANCREATIC INJURY IN A 6 YEARS CHILDREN

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2019-23-1-38-39 ◽

2019 ◽

Vol 23 (1) ◽

pp. 38-39

Author(s):

A. A. Baulin ◽

L. I. Pogozhev ◽

N. A. Popov ◽

V. P. Shishkanov ◽

V. V. Sretenskii ◽

...

Keyword(s):

Surgical Treatment ◽

Pancreatic Duct ◽

Postoperative Period ◽

Main Pancreatic Duct ◽

Clinical Case ◽

Pancreatic Injury ◽

Early Postoperative Period ◽

Complete Rupture

The article presents a clinical case of a traumatic complete rupture of the pancreas at the level of the isthmus in a 6-year-old child. Twelve hours after the injury, laparoscopy, laparotomy, a pancreas rupture at the level of the isthmus was performed. Surgical treatment consisted in stenting the main pancreatic duct with a catheter, carrying the latter through a large duodenal nipple, sealing the parenchyma of the gland, and draining the gland bag. In the early postoperative period, no complications were noted. The stent is removed 5 weeks after the operation. The catamnesis was followed for about a year, complications were not observed.

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A rare case of acute pancreatitis due to roundworm infestation

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20193299 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1346

Author(s):

Anant Parasher

Keyword(s):

Acute Pancreatitis ◽

Gastrointestinal Tract ◽

Supportive Care ◽

Pancreatic Duct ◽

Acute Abdomen ◽

Ascaris Lumbricoides ◽

Main Pancreatic Duct ◽

Rare Case ◽

Similar Case ◽

Human Gastrointestinal Tract

Roundworm or Ascaris lumbricoides is one of the most common parasitic infestations of the human gastrointestinal tract occurring particularly in tropical and temperate countries having hot and humid conditions. On rare occasions, it may invade the biliary tract and the main pancreatic duct causing obstruction and leading to acute pancreatitis. Here, a similar case is presented of a patient who presented with symptoms of acute abdomen and vomiting, with imaging suggestive of roundworm infestation in the main pancreatic duct and who later improved with supportive care.

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Main pancreatic duct obstruction due to pancreatic injury. A case report.

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) ◽

10.3919/jjsa.64.435 ◽

2003 ◽

Vol 64 (2) ◽

pp. 435-439

Author(s):

Asako MATSUSHIMA ◽

Yasuhiro SUMI ◽

Suguru SAWADA ◽

Naomasa YOSHIDA ◽

Yutaka OZEKI ◽

...

Keyword(s):

Case Report ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Pancreatic Injury ◽

Duct Obstruction ◽

Pancreatic Duct Obstruction

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Pancreas-preserving double pancreaticogastrostomy after traumatic injury to the head of the pancreas: a case report

Journal of International Medical Research ◽

10.1177/0300060520962967 ◽

2020 ◽

Vol 48 (10) ◽

pp. 030006052096296

Author(s):

Yuichi Aoki ◽

Hideki Sasanuma ◽

Yuki Kimura ◽

Akira Saito ◽

Kazue Morishima ◽

...

Keyword(s):

Gastrointestinal Bleeding ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Traumatic Injury ◽

Pancreatic Head ◽

Pancreatic Injury ◽

Roux Limb ◽

Pancreas Head ◽

Pancreatic Fluid ◽

Head Of The Pancreas

Traumatic injury to the main pancreatic duct requires surgical treatment, but optimal management strategies have not been established. In patients with isolated pancreatic injury, the pancreatic parenchyma must be preserved to maintain long-term quality of life. We herein report a case of traumatic pancreatic injury with main pancreatic duct injury in the head of the pancreas. Two years later, the patient underwent a side-to-side anastomosis between the distal pancreatic duct and the jejunum. Eleven years later, he presented with abdominal pain and severe gastrointestinal bleeding from the Roux limb. Emergency surgery was performed with resection of the Roux limb along with central pancreatectomy. We attempted to preserve both portions of the remaining pancreas, including the injured pancreas head. We considered the pancreatic fluid outflow tract from the distal pancreatic head and performed primary reconstruction with a double pancreaticogastrostomy to avoid recurrent gastrointestinal bleeding. The double pancreaticogastrostomy allowed preservation of the injured pancreatic head considering the distal pancreatic fluid outflow from the pancreatic head and required no anastomoses to the small intestine.

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

Journal of Medical Case Reports ◽

10.1186/s13256-020-02647-8 ◽

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.

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