Impact of a defined management algorithm on outcome after traumatic pancreatic injury

Abstract

Adherence to a defined ALG simplified the management of traumatic pancreatic injuries and contributed to a reduction in both pancreas-related morbidity and mortality. The majority of all proximal pancreatic injuries can be treated with drainage alone. For distal injuries, a clinical decision based on defined parameters and suspicion of ductal injury dictates definitive management.

Conservative and surgical management of pancreatic trauma in adult patients

“…As for pancreatic injury grades 1 and 2, the NOM is the most effective as long as there is no involvement of the main pancreatic duct. This strategy is effective since morbidity is less than 20% and mortality is relatively low (20,25). This is in accordance with our results which show that 80% (12/15) were successfully treated with this strategy.…”

“…For pancreatic injury grade 5 there are several possibilities varies from NOM to surgical drainage and up to pancreaticoduodenectomy. The published data favor NOM with satisfactory results (19,25), even in cases of duodenal or bile duct injuries (29). Pancreaticoduodenectomy is associated with high mortality rate (45%) while more conservative approach has much lower mortality rate of 22-25% (29-31).…”

“…This is in accordance with our results which show that 80% (12/15) were successfully treated with this strategy. As for grade 3 and 4 pancreatic injury, distal pancreatectomy or surgical drainage are the indication of choice for body-tail contused areas associated with distal pancreatic duct injury (1,25). Distal pancreatectomy is often preferred over drainage because it decreases mortality and the risk of operative complications (1,20,26).…”

The Epidemiology of and Outcome from Pancreatoduodenal Trauma in the UK, 1989–2013

“…New technology and new surgical strategies may have rendered many previous conclusions invalid. Most reported series, to date, are from the US [2][3][4]6,9,11,12,14 and South Africa, 5,13 and report a high proportion of penetrating trauma. The findings from these studies may therefore not be directly applicable to other countries with different patterns of trauma, such as the UK and much of Europe.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] This is often due to an associated vascular injury, owing to the proximity of the pancreas to the aorta, inferior vena cava, portal and superior mesenteric vessels. Early deaths are from haemorrhage, and late deaths from infection and sepsis.…”