Features of the development of traumatic pancreatitis with gunshot wounds to the abdomen

The features of the development of traumatic pancreatitis in gunshot wounds of the abdomen, which present difficulties in timely diagnosis, are considered, hypotheses are formulated for studying the problem. Two clinical cases of developing traumatic pancreatitis against the background of a gunshot wound to the abdomen with indirect damage to the pancreas are presented. Without taking into account the peculiarities of the formation of the wound canal relative to the organs of the abdomen, in conditions of limited diagnostic potential, there is a high probability of late diagnosis of traumatic pancreatitis, especially in indirect damage. Injuries to the organs of the upper half of the abdomen can be risk factors for indirect damage to the pancreas due to the effect of lateral impact energy and the formation of a temporary pulsating cavity. In general, the management of such wounded in a surgical hospital with limited diagnostic capabilities or with stage treatment in a local military conflict requires the surgeon to know the peculiarities of the course of traumatic pancreatitis, which make it possible to prevent the development of complications in a timely manner. The development of traumatic pancreatitis in penetrating gunshot wounds to the abdomen is not always a consequence of direct pancreatic injury. This circumstance must always be taken into account during a diagnostic laparotomy.

Laparoscopy for traumatic pancreatitis. Case report

Introduction: Traumatic pancreatitis (TP) comprises less than 10% of all abdominal traumas but can reach mortality and morbidity rates of up to 34% and 64%, respectively. The treatment of TP has a conservative approach, followed by minimally invasive procedures and surgery if the evolution is torpid.Case report: A 54-year-old male patient with blunt trauma in right hypochondrium due to a bovine kick developed moderate-severe TP and grade IV pancreatic injury (PI). He underwent laparoscopic surgery twice with adequate clinical evolution. He required antibiotic therapy for 19 days and hospitalization for 29 days, of which 9 were in the ICU.Conclusion: The diagnosis of TP is difficult to achieve due to the retroperitoneal location of the pancreas. The treatment of this condition is usually conservative, preferring clinical management with percutaneous or endoscopic drainage over surgical drainage due to its low morbidity and mortality. The recommended surgical approach to these patients is laparotomy; however, the laparoscopic approach is a therapeutic option to be considered for comprehensive management.

Trauma of the pancreas. A hidden disaster

Due to its anatomical position, traumatic lesions of the pancreas are rare and difficult to diagnose. Diagnosis time is paramount as an increase in duration translates into an increase in morbidity and mortality. Duct lesions are hard to identify on CT, ERCP being the investigation of choice but it is difficult to obtain as it requires highly specialized staff and equipment. Intraoperative macroscopic and palpatory evaluation of the pancreas in a trauma patient should be elective no matter what other lesions are present. The treatment is mainly dictated by this evaluation and is defined as it follows: stage I and II usually require a conservative approach; stage III, IV, and V usually imply resection of the pancreas although recent advances in conservative management have been made through ERCP and pancreatic duct stenting. In these stages, intraoperative evaluation should ensure the ampulla is intact if the head of the pancreas is not resected. Serum amylase and lipase levels do not offer a concrete direction towards a pancreatic lesion. Currently, there is no standard surgical treatment for these stages thus making intraoperative evaluation mandatory. One must remember that post-traumatic pancreatitis exists, which becomes apparent days after the accident.

PREDICTION METHOD FOR ACUTE TRAUMATIC PANCREATITIS IN SHOCK-INDUCING POLYTRAUMA

INTRODUCTION. Analysis of consideration of risk factors (RF) in the prediction and treatment of acute traumatic pancreatitis (ATP) based on studied sources has revealed that classic isolated RF cannot completely account for the dynamics and onset of ATP.The OBJECTIVE was to develop a system for early prediction of the probability of developing ATP in case of shockinducing polytrauma.MATERIAL AND METHODS. Our prediction model was based on retrospective analysis of case records of patients had injured in car crashes and slip-and-fall accidents. Clinical and mathematical simulation were employed to describe real cause-effect relations. The study left out isolated minor injuries, which did not imply any pancreatopathy RF. We compiled the selection of 469 shock-inducing polytrauma case records. Stepwise research was carried out to create the prediction system. RESULTS. We identified 15 RF affecting the probability of ATP development. Mathematical processing of obtained quantitative characteristics determined the predictive score (PS) of every RF (PS RF). The resulting cumulative PS RF were used as the basis to build a mathematical prediction model for the probability of ATP development. A lookup table was suggested for practical application in polytrauma surgery. The study carried out with reference on available sources and research works of the authors was used to stipulate basic principles for clinical and mathematical simulation of risk factors causing development of pancreatopathy in shock-inducing polytrauma situation within a traumatic disease case. The issues of pathology predicting were also highlighted. The paper offers a scientifically justified and elaborated predictive evaluation based on the system of risk factors affecting the ATP development.CONCLUSION. Implementation of the scoring evaluation method to identify the risk of pathology onset based on combinations of risk factors considerably increased informative value of predictions and improved the efficiency of individually tailored preventive measures corresponding to the risk of pancreatopathy in shock-inducing polytrauma cases.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

In trauma, expect the unexpected: a rare case of post-traumatic pancreatitis associated with salmonellosis and enterocolitis

A 16-year-old Hispanic man was transferred to our level I paediatric trauma centre with pancreatitis. Ten days prior, he had sustained a gunshot wound to the abdomen requiring an exploratory laparotomy for repair of a traumatic left diaphragmatic injury. Additional injuries included gastric, renal, liver and pancreatic lacerations as well as a T12 burst fracture that resulted in paraplegia. Conservative management of pancreatitis was unsuccessful over the next 10 days, resulting in progressive symptoms of severe unresolved pain, nausea, emesis and rising lipase. Workup for post-traumatic, biliary and drug-associated causes of pancreatitis was negative, and no anatomical abnormalities were found on imaging. A fever workup on hospital day 10 revealed a urinary tract infection with non-typhoidSalmonellasp, and subsequent stool and imaging studies revealed salmonellosis associated with right-sided colitis andClostridium difficileinfection. Pancreatitis resolved within 48 hours following treatment of salmonellosis andClostridium.