Abstract
Backgrounds/Aims
Traumatic pancreatic injury is rare and various surgical procedures can be applied according to the severity of injury. We reviewed our experience of pancreatic injury and investigated the clinical outcome.
Methods
Fifty-six patients were treated conservatively or with surgery for pancreatic injury at the Department of Surgery, Korea University Medical Center of Korea University College of Medicine from January 2001 to February 2012.
Results
Forty-one men and 15 women were included (mean age, 32 years; range, 5-66 years). Twelve patients were hypotensive at admission. According to the American Association for the Surgery of Trauma grade, 15 patients were grade I, 16 were grade II, 10 were grade III, 13 were grade IV, and one patient was grade V. A total of 41 patients underwent exploratory surgery. Complications developed in 35 patients, and 19 patients demonstrated intra-abdominal abscesses associated with pancreatic leakage. Four mortalities occurred. More adult patients (n=42) required intensive care than that of pediatric patients (n=14) (p=0.03). However, more pediatric patients had hyperamylasemia at admission (p=0.023). A significantly higher proportion of patients in the hypotensive group had blunt abdominal injuries, associated extra-abdominal injuries, combined intra-abdominal injuries, longer ICU stays, and a higher mortality rate.
Conclusions
Associated intra-abdominal and extra-abdominal injuries are frequent in patients with traumatic pancreatic injury. Despite the complication rate, most patients recovered. Mortalities were associated with combined injuries being placed into bleeding, hypovolemic shock, and multiorgan failure.
References
1. Lin BC, Chen RJ, Fang JF, et al. Management of blunt major pancreatic injury. J Trauma. 2004. 56:774–778.
2. Vasquez JC, Coimbra R, Hoyt DB, et al. Management of penetrating pancreatic trauma: an 11-year experience of a level-1 trauma center. Injury. 2001. 32:753–759.
3. Velmahos GC, Tabbara M, Gross R, et al. Blunt pancreatoduodenal injury: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg. 2009. 144:413–419.
4. Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin North Am. 2007. 87:1515–1532.
5. Tyburski JG, Dente CJ, Wilson RF, et al. Infectious complications following duodenal and/or pancreatic trauma. Am Surg. 2001. 67:227–230.
6. Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma. 1990. 30:1427–1429.
7. Antonacci N, Di Saverio S, Ciaroni V, et al. Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome? J Hepatobiliary Pancreat Sci. 2011. 18:195–201.
8. Thomas H, Madanur M, Bartlett A, et al. Pancreatic trauma--12-year experience from a tertiary center. Pancreas. 2009. 38:113–116.
9. Akhrass R, Kim K, Brandt C. Computed tomography: an unreliable indicator of pancreatic trauma. Am Surg. 1996. 62:647–651.
10. Patel SV, Spencer JA, el-Hasani S, Sheridan MB. Imaging of pancreatic trauma. Br J Radiol. 1998. 71:985–990.
11. Stawicki SP, Schwab CW. Pancreatic trauma: demographics, diagnosis, and management. Am Surg. 2008. 74:1133–1145.
12. Buccimazza I, Thomson SR, Anderson F, et al. Isolated main pancreatic duct injuries spectrum and management. Am J Surg. 2006. 191:448–452.
13. Tan KK, Chan DX, Vijayan A, et al. Management of pancreatic injuries after blunt abdominal trauma. Experience at a single institution. JOP. 2009. 10:657–663.
14. Wales PW, Shuckett B, Kim PC. Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children. J Pediatr Surg. 2001. 36:823–827.
15. Shilyansky J, Sena LM, Kreller M, et al. Nonoperative management of pancreatic injuries in children. J Pediatr Surg. 1998. 33:343–349.
16. Paul MD, Mooney DP. The management of pancreatic injuries in children: operate or observe. J Pediatr Surg. 2011. 46:1140–1143.
17. Jobst MA, Canty TG Sr, Lynch FP. Management of pancreatic injury in pediatric blunt abdominal trauma. J Pediatr Surg. 1999. 34:818–823.