Diagnosis and Management of High-Grade Pancreatic Trauma: Report of 14 Cases

Bao, Wan-Yuan; She, Gang; Duan, Yunfei; Liu, Shengyong; Sun, Donglin; Yang, Yue; Zhu, Feng

doi:10.1007/s12262-015-1258-z

Cited by 9 publications

(9 citation statements)

References 19 publications

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“…Pancreatic injuries with ductal disruption are of special significance. These injuries are associated with higher morbidity and mortality, greater incidence of associated organ injuries, delayed diagnosis [30] , [31] , [32] , [33] . Also these are unique when compared to other major abdominal solid visceral trauma (liver and spleen).…”

Section: Discussionmentioning

confidence: 99%

“…The leak of enzyme rich pancreatic juice into and surrounding the pancreas incites a vigorous inflammatory cascade with its sequale. Associated pancreatitis with necrosis, hemorrhage, abscess, pseudocysts, enteric fistulae and organ failures limit the physiological reserve and deserve special aspects of care [30] , [31] , [32] , [33] , [34] .…”

Section: Discussionmentioning

confidence: 99%

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Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

Koganti

Kongara

Boddepalli

et al. 2016

Annals of Medicine &Amp; Surgery

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IntroductionAlthough surgery is the preferred treatment for grade III&IV pancreatic trauma, there is a growing movement for non-operative management. in blunt pancreatic trauma. Very few studies compare operative versus non-operative management in adult patients.MethodsRetrospective analysis of a prospectively maintained database was performed from 2004 to 2013 in the department of gastrointestinal surgery, NIMS, Hyderabad. Comparative analysis was performed between patients who failed versus those who were successfully managed with non-operative management.Results34 patients had grade III/IV trauma out of which 8 were operated early with the remaining 26 initially under a NOM strategy, 10 of them could be successfully managed without any operation. Post-traumatic pancreatitis, Necrotizing pancreatitis, Ileus, contusion on CT, surrounding organ injuries are independently associated with failure of NOM on a univariate analysis. On multivariate logistic regression presence of necrosis& associated organ injury are factors that predict failure of NOM independently. Development of a pseudocyst is the only significant factor that is associated with a success of NOM.ConclusionsNon-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma. In hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

Koganti

Kongara

Boddepalli

et al. 2016

Annals of Medicine &Amp; Surgery

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“…Most of these patients require pancreaticoduodenectomy and present in shock and with severe associated injuries and should be treated with DCS [243]. Mortality after trauma Whipple remains high varying from 12 to 33%, but it may be improved with DCS techniques and appropriate patient selection [231, 244, 245]. Mortality with more conservative surgical treatments (duodenal reconstruction and drainage) appears to be similar, but complications, particularly pancreatic fistula, may be higher when compared with the Whipple procedure [13, 246].…”

Section: Methodsmentioning

confidence: 99%

“…US or CEUS is used as an alternative to CT for follow-up of fluid collections, pseudocysts, and pancreatic disruptions after pancreatic trauma mainly in children or in low-resource settings [16, 26, 40, 45, 49, 53, 55, 63, 71, 75, 78, 133, 134, 138, 245, 247, 251–254]. CEUS may improve results of pancreatic imaging, being nearly as accurate as CT-scan and reducing radiation exposure in children [249, 255, 256].…”

Section: Methodsmentioning

confidence: 99%

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

et al. 2019

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Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

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“…A total of 37 studies were included. 1,4,6 -40 There were 34 published journal articles, 2 conference abstracts, and 1 published conference presentation. In 21 of the studies, imaging of PI was the primary objective.…”

Section: Resultsmentioning

confidence: 99%

Imaging of Blunt Pancreatic Trauma: A Systematic Review

2020

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Purpose: Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. Methods: Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. Results: After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. Conclusion: There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.

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Diagnosis and Management of High-Grade Pancreatic Trauma: Report of 14 Cases

Abstract: The aim of this study was to review the diagnosis and operative management of cases of high-grade pancreatic trauma.

Cited by 9 publications

References 19 publications

Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

Predictors of successful non-operative management of grade III & IV blunt pancreatic trauma

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Imaging of Blunt Pancreatic Trauma: A Systematic Review

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