Delayed Gastrointestinal Reconstruction Following Massive Abdominal Trauma

Carrillo, Carlos; Fogler, Richard; Shaftan, Gerald W.

doi:10.1097/00005373-199302000-00009

Cited by 70 publications

(25 citation statements)

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“…The patient is then stabilised on the intensive care unit (ICU) and a second laparotomy is performed after 48 hours for reconstruction. 36 No studies have evaluated the safety of pancreaticogastrostomy versus pancreaticojejunostomy in the trauma setting. It should only be performed by an experienced HPB surgeon in a tertiary unit with adequate ICU and radiological support.…”

Section: Operative Managementmentioning

confidence: 99%

Pancreatic trauma

Lahiri

Bhattacharya

2013

annals

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INTRODUCTION Pancreatic trauma occurs in approximately 4% of all patients sustaining abdominal injuries. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury. Immediate resuscitation and investigations are essential to delineate the nature of the injury, and to plan further management. If main pancreatic duct injuries are identified, specialised input from a tertiary hepatopancreaticobiliary (HPB) team is advised. METHODS A comprehensive online literature search was performed using PubMed. Relevant articles from international journals were selected. The search terms used were: 'pancreatic trauma', 'pancreatic duct injury', 'radiology AND pancreas injury', 'diagnosis of pancreatic trauma', and 'management AND surgery'. Articles that were not published in English were excluded. All articles used were selected on relevance to this review and read by both authors. RESULTS Pancreatic trauma is rare and associated with injury to other upper abdominal viscera. Patients present with nonspecific abdominal findings and serum amylase is of little use in diagnosis. Computed tomography is effective in diagnosing pancreatic injury but not duct disruption, which is most easily seen on endoscopic retrograde cholangiopancreaticography or operative pancreatography. If pancreatic injury is suspected, inspection of the entire pancreas and duodenum is required to ensure full evaluation at laparotomy. The operative management of pancreatic injury depends on the grade of injury found at laparotomy. The most important prognostic factor is main duct disruption and, if found, reconstructive options should be determined by an experienced HPB surgeon. CONCLUSIONS The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and in these cases, experienced HPB surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery.

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Section: Operative Managementmentioning

confidence: 99%

Pancreatic trauma

Lahiri

Bhattacharya

2013

annals

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“…The nature and severity of the injury and the coexisting damage to vessels is often accompanied by hemody- namic instability and the surgeon must therefore perform damage control surgery, and delay formal reconstruction until the patient has been stabilized [41]. The results of this operation vary, and when patients with major retroperitoneal vascular injuries are included mortality can reach 50% [42].…”

Section: Pancreaticoduodenectomy (Whipple's Procedure)mentioning

confidence: 99%

Injuries to the Pancreaticoduodenal Complex

Boffard

2008

Eur J Trauma Emerg Surg

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Injuries to the pancreaticoduodenal complex present a significant challenge both in diagnosis and management. The retroperitoneal location of the pancreas means that it is not a common site of injury, but this also contributes to the difficulty in diagnosis, as the organ is concealed, and investigation often results in delay with its attendant increase in morbidity. The increase in violence in society, particularly of penetrating injuries and the increase in energy of wounding from gunshots, has made pancreatic injury more common. In many cases the surgical management is relatively simple, but occasionally complex and technical surgical solutions are necessary and the position of the pancreas makes its access and all procedures on it challenging. To compound this, pancreatic trauma is associated with a high incidence of injury to adjoining organs and major vascular structures, which adds to the high morbidity and mortality, and complications occur in 30-60% of patients [1, 2].

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“…However, occasionally split-thickness skin grafts or even tissue transfer techniques may be necessary. Complications of extremity injuries include compartment syndrome, ischaemia with resultant amputation 17 and deep vein thrombosis 18 with venous hypertension; they are associated with a high mortality rate.…”

Section: Extremity Injurymentioning

confidence: 99%

Damage control in the abdomen and beyond

Loveland

Boffard

2004

British Journal of Surgery

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Damage control surgery, sometimes known as 'damage limitation surgery' or 'abbreviated laparotomy', is best defined as creating a stable anatomical environment to prevent the patient from progressing to an unsalvageable metabolic state. Patients are more likely to die from metabolic failure than from failure to complete organ repairs. It is with this awareness that damage control surgery is performed, enabling the patient to maintain a sustainable physiological envelope.

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Delayed Gastrointestinal Reconstruction Following Massive Abdominal Trauma

Cited by 70 publications

References 0 publications

Pancreatic trauma

Pancreatic trauma

Injuries to the Pancreaticoduodenal Complex

Damage control in the abdomen and beyond

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