Current status and management of pancreatic trauma with main pancreatic duct injury: A multicenter nationwide survey in Japan

Abstract

Background: Pancreatic trauma is reportedly associated with high morbidity and mortality. Main pancreatic duct (MPD) injury is critical for treatment. Methods: As a study project of the Japanese Society for Abdominal Emergency Medicine (JSAEM), we collected the data of 163 patients with pancreatic trauma who were diagnosed and treated at JSAEM board-certified hospitals from 2006 to 2016. Clinical backgrounds, diagnostic approaches, management strategies, and outcomes were evaluated. Results: Sixty-four patients (39%) were diagnosed as having pancreatic trauma with MPD injury that resulted in 3% mortality. Blunt trauma and isolated pancreatic injury were independent factors predicting MPD injury. Nine of 11 patients with MPD injury who were initially treated nonoperatively had serious clinical sequelae and five (45%) required surgery as a secondary treatment. Among all cases, the detectability of MPD injury of endoscopic retrograde pancreatography (ERP) was superior to that of other imaging modalities (CT or MRI), with higher sensitivity and specificity (sensitivity = 0.96; specificity = 1.0). Conclusions: Acceptable outcomes were observed in pancreatic trauma patients with MPD injury. Nonoperative management should be carefully selected for MPD injury. ERP is recommended to be performed in patients with suspected MPD injury and stable hemodynamics. K E Y W O R D S endoscopic retrograde pancreatography, main pancreatic duct injury, management, nationwide survey, pancreatic trauma This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Pancreatic trauma with main pancreatic duct injury

“…1 We concur that major pancreatic injuries still result in considerable morbidity, even when treated in well-resourced referral centers, and strongly endorse the notion proposed by the authors that experienced teams should be involved in the management of such injuries as in the JSAEM study. 1 We agree that it is judicious to involve a proficient pancreatic surgeon at an early stage as the technical intricacies both for resection and reconstruction of complex pancreatic injuries require special organ-specific surgical skills and expertise. 2 The authors do not detail the specifics, but current data support the use of initial damage-control laparotomy for complex combined pancreaticoduodenal injuries and delayed pancreatoduodenectomy (PD) once compromised patient physiology has been corrected.…”

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Dear Editor, We congratulate Drs Ando and Okano and colleagues from the Japanese Society for Abdominal Emergency Medicine (JSAEM) on their excellent analysis and the exceptional outcome of patients treated for main pancreatic duct (MPD) injuries. 1 We concur that major pancreatic injuries still result in considerable morbidity, even when treated in well-resourced referral centers, and strongly endorse the notion proposed by the authors that experienced teams should be involved in the management of such injuries as in the JSAEM study. 1 We agree that it is judicious to involve a proficient pancreatic surgeon at an early stage as the technical intricacies both for resection and reconstruction of complex pancreatic injuries require special organ-specific surgical skills and expertise.

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Indications for the surgical management of pancreatic trauma: An update

“…A recent multicenter national survey in Japan showed that serum amylase levels and ERCP can more accurately indicate injury to the main pancreatic duct in hemodynamically stable patients. Poor outcomes were reported in patients with long-standing injuries who were initially managed nonoperatively[ 13 ].…”

Open or Not Open the Retroperitoneum: A Pandora’s Box for High-grade Pancreatic Trauma?

“…NOM strategies combined with internal and external drainage is thought to be bene cial in the acute and delayed phase by inducing less surgical stress, thereby lowering the in ammatory cascade, especially in already critically ill patients with serious injury [25,31,32]. This, considering the fact that pancreatic trauma is a complex and rare disease, makes it unlikely that a trial with a su ciently large sample size to study clinical outcomes will ever be performed [4,22,24,26,33,34]. It therefore remains unclear if NOM strategies improve prognosis, especially in the context of other recent changes in the treatment.…”