An AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?

Byrge, Nickolas; Heilbrun, Marta E.; Winkler, Nicole; Sommers, Daniel; Evans, Heather L.; Cattin, Lindsay; Scalea, Tom; Stein, Deborah M.; Neideen, Todd; Walsh, Pamela; Sims, Carrie A.; Brahmbhatt, Tejal S.; Galante, Joseph M.; Phan, Ho H.; Malhotra, Ajai K.; Stovall, Robert T.; Jurkovich, Gregory J.; Coimbra, Raúl; Berndtson, Allison E.; O’Callaghan, Thomas; Gaspard, Scott F; Schreiber, Martin A.; Cook, Mackenzie R.; Δημητριάδης, Δημήτριος; Rivera, O. Conde; Velmahos, George C.; Zhao, Ting C.; Park, Pauline K.; Machado-Aranda, David; Ahmad, Salman; Lewis, J. B.; Hoff, William S.; Suleiman, Ghada; Sperry, Jason L.; Zolin, Samuel J.; Carrick, Matthew M.; Mallory, Gina R; Nunez, Jade; Colonna, Alexander L.; Enniss, Toby M.; Nirula, Ram

doi:10.1097/ta.0000000000001987

Cited by 35 publications

(48 citation statements)

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“…Presence and type of associated injuries greatly impact the treatment of duodenal trauma [1, 2, 7–12]. Penetrating trauma is the most common cause of duodenal injury (DI) in adult patients, accounting for 53.6–90% of cases [2, 8–10, 12, 13]. Pediatric DI is most frequently due to blunt trauma which occurs in 70–78% of cases.…”

Section: Introductionmentioning

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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Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…3 This is likely caused by the limitation we applied on the implementation NOM to minor grades of injury. 18,26 Surgery for minor pancreatic injuries with intact pancreatic duct (grades I and II) require simple surgical repair. 2 We omitted NOM in 14 patients (3 and 11 in groups B and C, respectively) with minor pancreatic injuries due to hemodynamic instability in group B and other organ injury in group C. All pancreatic injuries were adequately controlled by hemostasis, debridement and suture repair of parenchymal lacerations.…”

Section: Discussionmentioning

confidence: 99%

Surgical management of traumatic pancreatic injuries and their consequences.

El‐Badry

Ali

2020

Int Surg J

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Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.

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“…Once pancreatic injury is detected, it is important to evaluate its severity, as it correlates with the need for surgery and with the rate of complications (16), and the presence of coexistent injuries.…”

Section: Mdct Findingsmentioning

confidence: 99%

“…third of the patients and include pancreatitis, pseudocysts, fistulas, intra-abdominal abscesses, or bowel anastomosis breakdown, and may lead to sepsis and multiorgan failure (16). Post-traumatic leakage of pancreatic enzymes may lead to pseudocyst formation ( Figures 12,16,17) with further complication as abscesses, or may predispose to abnormal fistulization between the pancreas and adjacent organs.…”

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confidence: 99%

“…Post-traumatic leakage of pancreatic enzymes may lead to pseudocyst formation ( Figures 12,16,17) with further complication as abscesses, or may predispose to abnormal fistulization between the pancreas and adjacent organs. Furthermore, leakage of enzymes may lead to vascular wall erosion forming pseudoaneurysm that may complicate with delayed hemorrhage (16). Pseudoaneurysm development after trauma may also depend on variation in the blood flow following stenosis or occlusion of the celiac or hepatic arteries (26).…”

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confidence: 99%

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Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience

Iacobellis

Laccetti

Tamburrini³

et al. 2019

Gland Surg

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Pancreatic injuries can occur from either penetrating or blunt abdominal trauma. While there are rare, especially in the setting of blunt abdominal trauma, they are associated with a mortality of up to 30%, and a morbidity of 60%. Multidetector computed tomography (MDCT) is the preferred imaging modality in patients with acute blunt abdominal trauma and for the detection of acute pancreatic injury. Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) plays an important role in the follow-up of pancreatic injury. In this brief review, we discuss the main MDCT acute imaging findings as well as the complications. Finally, we discuss the role of MR and MRCP in follow up of patients with pancreatic injuries.

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An AAST-MITC analysis of pancreatic trauma: Staple or sew? Resect or drain?

Abstract: Epidemiologic/Diagnostic study, level III.

Cited by 35 publications

References 41 publications

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

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

Surgical management of traumatic pancreatic injuries and their consequences.

Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience

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