Detecting Blunt Pancreatic Injuries

Cirillo, R; Koniaris, Leonidas G.

doi:10.1016/s1091-255x(01)00028-2

Cited by 116 publications

(83 citation statements)

References 68 publications

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“…11 However, there is conflicting evidence, with another study showing that over 30% of patients with severe pancreatic trauma have serum amylase levels within normal parameters. 12,13 Helical multislice computed tomography (CT) is the non-invasive imaging modality of choice in patients with abdominal trauma. Triple phase CT in haemodynamically stable patients has been shown to have a sensitivity and specificity as high as 80% 14 in detecting pancreatic injury (Fig 1).…”

Section: Presentationmentioning

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: Presentationmentioning

confidence: 99%

Pancreatic trauma

Lahiri

Bhattacharya

2013

annals

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“…C/T sensitivity for pancreatic trauma is reported to be 85% for the first 24 hours and 90% overall. In the first 12 hours after injury, C/T may appear normal but a continued vigilance with repeated C/T is warranted in stable patients suspicious for pancreatic trauma [11].The newer multidetector C/T (MDCT) offers much greater sensitivity and specificity (91%) for the diagnosis of pancreatic duct injury [12]. If the C/T is equivocal or there are signs of pancreatic injury, Endoscopic Retrograde Cholangiopancreatography (ERCP) is the gold standard method for defining the integrity of the pancreatic duct which lished by the American Association for the Surgery of Trauma (AAST) which acknowledges the significance of complex injuries affecting the pancreatic duct and the head of the pancreas (table III) [15].…”

Section: Resultsmentioning

confidence: 99%

“…Distal transection or parenchymal injury with Isolated pancreatic trauma is associated with a 3%-10% mortality rate; mortality and morbidity are directly related to the degree of pancreatic injury and the integrity of the pancreatic duct, particularly if there is a delay in the detection of the pancreatic duct disruption [11,17]. According to Leppaniemi et al, mortality in proximal pancreatic injuries (head and neck) reaches 19% and in distal injuries (tail) 17% [29].…”

Section: Discussionmentioning

confidence: 99%

“…In Farrell's et al retrospective review of 51 patients with pancreatic trauma, 7 AAST grade IV and 7 AAST grade V injuries were identified: 2 involved The Current Management of Pancreatic Trauma providing the patient is haemodynamically stable and asymptomatic [11,21,33,34]; it is also a viable choice if surgical intervention is contraindicated due to the presence of comorbidities [9]. Patients with complete duct transection should be offered surgery [21].…”

Section: Management Of Aast Classified Injuries Grade IV and Vmentioning

confidence: 99%

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The current management of pancreatic trauma

et al. 2010

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“…The diagnosis and initial management of hemodynamically stable blunt pancreatic trauma should include a high index of suspicion when a patient has sustained a severe force vector in the anterior-posterior direction of the abdominal cavity. In patients experiencing blunt trauma, CT scans provide the best overall method for diagnosis and recognition of a pancreatic injury [23]. Retroperitoneal hematoma, retroperitoneal fluid, free abdominal fluid and pancreatic edema frequently accompany injuries to the pancreas.…”

Section: Introductionmentioning

confidence: 99%

Current Trends in the Management of Blunt Solid Organ Injuries

Taviloğlu

Yanar

2009

Eur J Trauma Emerg Surg

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The management of patients with solid organ injuries has changed since the introduction of technically advanced imaging tools, such as ultrasonography and multiple scan computerized tomography, interventional radiological techniques and modern intensive care units. In spite of this development in the management of these patients, major solid organ traumas can still be challenging. There has been great improvement in the non-operative management (NOM) of intra-abdominal solid organ injury in recent decades. In most cases treatment of injuries has shifted from early surgical treatment to NOM.

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Detecting Blunt Pancreatic Injuries

Cited by 116 publications

References 68 publications

Pancreatic trauma

Pancreatic trauma

The current management of pancreatic trauma

Current Trends in the Management of Blunt Solid Organ Injuries

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