Diagnosis and Management of Blunt Pancreatic Trauma

Abstract

Introduction: Blunt or penetrating pancreatic trauma represents only 0.2-2% of all trauma cases and approximately 3-12% of all abdominal injuries. While treatment protocol debates of other intra-abdominal and thoracic organ injuries seem to reach comforting conclusions, satisfying evidence-based recommendations regarding the pancreas have not been released yet. However, high grade trauma of the pancreas can lead to substantial morbidity and mortality. The question is, when and how to treat it conservatively or operatively. Objectives/Methods: This study is a review of contemporary literature on children and adult pancreatic trauma management strategies and findings. The purpose is to evaluate current classifications and the efficacy of subsequent non-operative and operative treatments. We list the established grading systems starting from physical examination, imaging diagnosis, to indications for surgery or conservative management, followed by post-treatment morbidity and mortality rates. Conclusions: Current operative or non-operative management strategies are not based on randomized -or even, in fact, on prospective -clinical trials. Most of the available publications demonstrate small retrospective patient cohorts and expert opinions. To date, no convincing high level (at least Level III) evidence-based recommendations have been published in terms of treatment of these injuries. There is a general agreement, that the injury of the main pancreatic duct is the thin red line, dividing conservative and operative strategies. Low grade pancreatic injury can be treated conservatively not significantly different from protocols developed for mild pancreatitis of other origin. Pancreatic duct damage in adults requires either minimal invasive intervention or exploration and reconstruction/resection via laparotomy. Treatment strategies of high grade paediatric pancreatic injuries remain controversial. Associated organ injuries can mask the symptoms of pancreatic trauma. Missed main pancreatic duct injuries pose a clinically challenging situation with serious complications and considerable mortality. Pancreatic injury in polytrauma poses the highest risk. Present perspectives for survival of pancreatic injury as mono trauma varies between 95-100%, while as a part of polytrauma, the mortality rate is as high as 30-35%. Multicentre prospective, randomized clinical trials would be ideal to support optimal decision making. Heterogeneity of cases and relative rarity of the pathology makes the creation of such a database highly unlikely.Pancreatic injury makes up a relatively small proportion of trauma cases: the pancreas is affected in 0.2-2% of all trauma patients and in 2-12% of all

A novel machine learning-assisted clinical diagnosis support model for early identification of pancreatic injuries in patients with blunt abdominal trauma: a cross-national study

“…It has been reported that 14% to 80% of patients with blunt injuries of the pancreas have elevated serum amylase and lipase, whereas 30% to 35% of patients still have normal levels in the early stage, even if their pancreas is completely transected. [4,7,9,10] Moreover, the sensitivity of other diagnostic tools such as computed tomography (CT) in the early detection of pancreatic injuries also varies, ranging from 28% to 85%, especially for injuries to the main pancreatic duct, while the sensitivity of high-resolution CT is only able to reach 54%. [11,12] Alternatively, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography have been reported to not only have a high diagnostic rate for pancreatic trauma but also a high sensitivity for injuries to the main pancreatic duct.…”

Pancreatoduodenectomía de urgencia. Revisión de 2 casos clínicos.

“…Los pacientes hemodinámicamente inestables necesitan una exploración quirúrgica inmediata, a menudo con una Cirugía de Control de Daños (CCD). Las intervenciones reconstructivas deben planificarse en una etapa posterior, cuando los factores potencialmente letales (hemorragia, shock, peritonitis, acidosis, hipotermia o coagulopatía) sean manejados adecuadamente, logrando una estabilización del paciente 2,4 .…”

Establishment of a multifunctional impact system and a study of a pancreatic trauma model in rats based on controlling the injury area

“…As a retroperitoneal organ, the pancreas is located behind multiple organs. Due to its special anatomical position, it is difficult to identify injury, which delays treatment time and confers a high mortality rate [ 3 ]. Furthermore, a posttraumatic reinjury effects will occur because the pancreas produces many digestive enzymes [ 4 ].…”