Journal List > Korean J Hepatobiliary Pancreat Surg > v.16(4) > 1040559

Kang, Choi, and Choi: Surgical experience and clinical outcome of traumatic pancreatic injury

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.

Figures and Tables

Table 1
Management of pancreatic injury according to American Association for the Surgery of Trauma (AAST) grade
kjhbps-16-160-i001

PJ, pancreaticojejunostomy; PG, Pancreaticogastrostomy; PPPD, pylorus-preserving pancreaticoduodenectomy

Table 2
Occurrence of complication following conservative or surgical treatment of pancreatic injury
kjhbps-16-160-i002

AAST grade, American Association for the Surgery of Trauma grade; DIC, disseminated intravascular coagulation; MOF, multi-organ failure

Table 3
Comparison of clinical characteristics between pediatric and adult patients
kjhbps-16-160-i003

ER, emergency room; AAST grade, American Association for the Surgery of Trauma grade. *Calculated with independent smples t-test, Calculated with Mann-Whitney U test

Table 4
Clinical characteristics between normotensive and hypotensive patients at initial admission
kjhbps-16-160-i004

ER, emergency room; AAST grade, American Association for the Surgery of Trauma grade. *Calculated with independent smples t-test, Calculated with Mann-Whitney U test

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