Pancreatic Trauma Revisited* |
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Authors: | Anuradha Subramanian David V Feliciano |
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Institution: | (1) Baylor College of Medicine, Houston, TX, USA;(2) Emory University School of Medicine, USA;(3) Grady Memorial Hospital, 69 Jesse Hill Jr Drive SE, #304, Atlanta, GA 30303, USA;(4) Grady Memorial Hospital, 69 Jesse Hill Jr Drive SE, #304, Atlanta, GA 30303, USA |
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Abstract: | Abstract Pancreatic trauma is rare with an incidence between one and two percent in patients with abdominal trauma. Morbidity and mortality,
however, are significant with rates approaching 40–45% in some reports. The majority of patients with injuries to the pancreas
have associated trauma to other organs which are primarily responsible for the high mortality rate. The continuity of the
main pancreatic duct is the most important determinant of outcome after injury to the pancreas. If there is no evidence of
ductal injury on fine-cut CT or on ERCP, nonoperative management is chosen. The indications for operative management are as
follows: (1) peritonitis on physical examination; (2) hypotension and a positive FAST; and (3) evidence of disruption of the
pancreatic duct on fine-cut CT or on ERCP. After exposure and evaluation of the extent of injuries to the pancreas and duodenum,
a decision must be made on the procedure. For pancreatic contusions, hematomas, or small lacerations, simple external drainage
or pancreatorrhaphy with drainage can be performed. For ductal transection at the neck, body, or tail, the procedure of choice
is a distal pancreatectomy or Roux-en-Y distal pancreatojejunostomy. If the patient has suffered a ductal transection at the
head of the pancreas without injury to the duodenum, a Roux-en-Y distal pancreatojejunostomy or anterior Roux-en-Y pancreatojejunostomy
is the operation of choice. For combined pancreatoduodenal injuries, the options are repair and drainage, diversion via a
pyloric exclusion procedure, or pancreatoduodenectomy. Complications of pancreatic injuries include fistulas and intra-abdominal
abscesses, and an occasional pancreatic pseudocyst. Key Words
*Please see related articles in Eur J Trauma Emerg Surg 33;3:221–37 |
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Keywords: | Modern Management of pancreatic trauma |
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