Conservative endoscopic management for pancreatic trauma

Abstract

Traumatic pancreatic injuries are rare: their severity correlates with main pancreatic duct involvement. We report the case of a 5-year-old child who presented with complete disruption of the main pancreatic duct, treated successfully with an endoscopically inserted double pigtail stent.

Clinical update on management of pancreatic trauma

“…10 Notably, data are based on case series with variable outcome, but endoscopic management has gained both popularity and success, even for main duct disruptions. 10,27,[66][67][68][69][70] Specific endoscopy-based scoring systems for pancreatic duct disruption after blunt trauma have been proposed in a small series from Kanagawa, Japan 71 and a later modified version from Cape Town, South Africa. 67 These scores are quite detailed, with 4-5 categories and several subcategories, thus questioning the robustness of each subcategory.…”

Endoscopic stenting in grade III pancreatic injury according to the American Association for the Surgery of Trauma – a systematic review of case reports and case series

“…Pancreatic duct strictures were observed in four patients (11.8%). Pseudocysts appeared in 8/34 cases (23.5%): in two cases percutaneous drainage was needed [10,11], and in another two cases cysto-duodenostomy or cysto-gastrostomy was performed [2,8]. In the remaining pseudocyst cases, a transpapillary stent was inserted in a 14-year-old patient who eventually required surgery [5], two patients were treated conservatively [5,12], and one case had no information about the management of the pseudocyst [5].…”

“…On the other hand, non-operative management of pancreatic duct injuries may lead to atrophy of the distal pancreas. Moreover, there is an increased risk for both main pancreatic duct stenosis and post-ERCP pancreatitis [7][8][9].…”

Endoscopic Transpapillary Stenting of Pancreatic Duct in Pancreatic Trauma AAST III: Clinical Observation

“…Ранним клиническим проявлением травмы ПЖ является выраженный болевой синдром с локализацией боли в верхней половине живота. В более поздние сроки травма ПЖ может манифестировать осложнениями: псевдокисты, абсцессы, панкреатические фистулы, стриктуры протока ПЖ (ППЖ), псевдоаневризмы артерий с рецидивирующими приступами панкреатита [2,4,[6][7][8][9]. Травма ПЖ характеризуется тяжелым течением и высокой летальностью, достигающей 50-60% [1,10].…”

“…Оценить состояние ППЖ по данным компьютерной томографии (КТ) -довольно сложно, поскольку чувствительность метода невысока и составляет от 52,4 до 60%, а специфичность -от 80 до 94,8% [4,5,7,12,13]. Признаками травмы ПЖ при КТ являются наличие жидкости между селезеночной веной и ПЖ, перипанкреатические жидкостные скопления, разрывы паренхимы железы, гематомы, экстравазация контрастного препарата -КП [3].…”