Laparoscopic non-resectional management of grade III isolated pancreatic injury

Abstract Background Pancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries. Case presentation A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications. Conclusions Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.

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Successful combination strategy of preoperative placement of an endoscopic nasopancreatic drainage catheter and pancreas preservation surgery for pancreatic injury with major pancreatic duct disruption: a case report

Surgical Case Reports ◽

10.1186/s40792-019-0743-1 ◽

2019 ◽

Vol 5 (1) ◽

Author(s):

Kenji Kandori ◽

Wataru Ishii ◽

Ryoji Iizuka

Keyword(s):

Pancreatic Duct ◽

Pancreatic Resection ◽

Pancreatic Injury ◽

Combination Strategy ◽

Pancreatic Body ◽

First Case ◽

Endoscopic Nasopancreatic Drainage ◽

Pancreas Preservation ◽

Nasopancreatic Drainage ◽

Grade Iii

Abstract Background The guidelines recommend pancreatic resection for grade III and IV pancreatic injuries. On the other hand, organ preservation is an important issue. Herein, we present the first case of pancreatic injury with major pancreatic duct (MPD) disruption that was treated with the combination of preoperative placement of endoscopic nasopancreatic drainage (ENPD) catheter and pancreas preservation surgery after endoscopic pancreatic stenting (EPS) failure. Case presentation A 70-year-old female diagnosed with pancreatic injury was admitted to our hospital. She was hemodynamically stable. ERP revealed MPD disruption, and EPS failed. An ENPD catheter was placed preoperatively at the site of injury. During laparotomy, we identified a partial-thickness laceration in the pancreatic body. At the site of injury, the tip of the ENPD catheter was found; therefore, the patient was diagnosed with grade III pancreatic body injury with MPD disruption. The extent of crush was not severe, and we had no difficulty in identifying the distal MPD segment. We inserted the ENPD catheter into the distal MPD segment. The ruptured MPD and the laceration was sutured, then pancreatic resection was prevented. She was discharged on POD 56. Conclusion The treatment strategy incorporated ERP, placement of an ENPD catheter preoperatively, and a simple surgery in a hemodynamically stable patient with pancreatic injury allows the pancreas and spleen to be preserved.

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Blunt trauma – related isolated pancreatic injury

Bratislava Medical Journal ◽

10.4149/bll_2013_108 ◽

2013 ◽

Vol 114 (09) ◽

pp. 519-522 ◽

Cited By ~ 1

Author(s):

A. Onder ◽

M. Kapan ◽

G. Tekbas ◽

Z. Arikanoglu ◽

I. Aliosmanoglu ◽

...

Keyword(s):

Blunt Trauma ◽

Pancreatic Injury ◽

Isolated Pancreatic Injury

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Case Series : Operative vs Non-Operative Management in Grade III Pancreatic Injury

Medicinus ◽

10.19166/med.v7i6.2598 ◽

2020 ◽

Vol 7 (6) ◽

pp. 199

Author(s):

Andry Irawan ◽

Clinton Clinton ◽

Sutanto D ◽

Agustina F

Keyword(s):

Case Series ◽

Operative Management ◽

Pancreatic Injury ◽

Clinical Findings ◽

First Case ◽

Non Operative Management ◽

Left Abdomen ◽

Grade Iii ◽

Selection Of

Introduction: Pancreatic injury is a rare case, caused by blunt or sharp trauma. Difficulty in making diagnose on pancreatic trauma cases are associated with high mortality, and the treatment can be either operative or conservatively. However, It is still unclear which treatment is more favorable.Case: We present 2 cases of Grade III pancreatic injury with stable hemodynamic who suffered bicycle accident. First case, 12-year-old boy complaining severe pain on the upper left abdomen (VAS 9-10) and get worsening by time, with vomiting. The patient underwent distal Pancreatectomy-Splenectomy. Second case, 8-year-old boy complaining of pain on the upper left abdomen (VAS 6-7) without extension on whole abdominal region with vomiting and fever. The patient was treated conservatively. In both cases, patient was discharged with improvement. However, about 3 months later patients who were treated conservatively developed into a pseudocyst.Conclusion: The selection of management in grade III pancreatic injury can be operative or conservative depending on clinical findings such as hemodynamic condition and the quality of abdominal pain. But the occurrence of pseudocysts pancreas is another surgical challenge.

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Internal Drainage into an Onlay-Roux-en-Y Jejunal Loop in Isolated Pancreatic Injury with Ductal Transection: Short-Term and Long-Term Follow-Up in Two Pediatric Cases

European Journal of Pediatric Surgery ◽

10.1055/s-2008-1072400 ◽

2000 ◽

Vol 10 (06) ◽

pp. 398-401 ◽

Cited By ~ 4

Author(s):

A. Mboyo ◽

V. Flurin ◽

P. Allamand ◽

T. Fenni ◽

B. Bour ◽

...

Keyword(s):

Pancreatic Injury ◽

Jejunal Loop ◽

Internal Drainage ◽

Short Term ◽

Long Term Follow Up ◽

Isolated Pancreatic Injury

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Complete pancreatic duct disruption in an isolated pancreatic injury: successful endoscopic management

Oxford Medical Case Reports ◽

10.1093/omcr/omw010 ◽

2016 ◽

Vol 2016 (3) ◽

pp. 44-46 ◽

Cited By ~ 1

Author(s):

Dilip Chakravarty Kottapalli ◽

Sreenivasa Devashetty ◽

Vishwanath Reddapagari Suryanarayana ◽

Mounika Kilari ◽

Mohamed Dawood Ismail ◽

...

Keyword(s):

Pancreatic Duct ◽

Pancreatic Injury ◽

Endoscopic Management ◽

Pancreatic Duct Disruption ◽

Isolated Pancreatic Injury ◽

Duct Disruption

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Internal Drainage into an Onlay-Roux-en-Y Jejunal Loop in Isolated Pancreatic Injury with Ductal Transection: Short-Term and Long-Term Follow-Up in Two Pediatric Cases

European Journal of Pediatric Surgery ◽

10.1055/s-2000-12061 ◽

2000 ◽

Vol 10 (6) ◽

pp. 398-401

Author(s):

A. Mboyo ◽

V. Flurin ◽

P. Allamand ◽

T. Fenni ◽

B. Bour ◽

...

Keyword(s):

Pancreatic Injury ◽

Jejunal Loop ◽

Internal Drainage ◽

Short Term ◽

Long Term Follow Up ◽

Isolated Pancreatic Injury

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Primary Repair of Traumatic Complete Pancreatic Rupture

The American Surgeon ◽

10.1177/00031348211038566 ◽

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.

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