Management and outcome of patients with pancreatic trauma

Abstract

Introduction:Pancreatic trauma is a rare entity occurring in 0.2% of patients with blunt trauma abdomen. Once the diagnosis is made, the management of patients is dependent on multiple variables. Conservative management, suture repair, drainage, and resection have been utilized with varying degree of success. This study is aimed to evaluate the management of patients with pancreatic trauma.Materials and Methods:This was a prospective study done in the Department of Surgery in Dayanand Medical College and Hospital where forty hemodynamically stable patients diagnosed to have pancreatic trauma on contrast-enhanced computed tomography abdomen were included in the study.Results:Out of forty patients taken in this study, 38 were male and two were female with age ranging from 3 to 50 years. Road traffic accident was the most common cause of pancreatic injury. Pancreatic injuries were graded according to the American Association for Surgery in Trauma scale. Twelve patients had Grade I and II injuries. Grade III was the most common injury occurring in 14 patients. Twenty-four patients underwent surgical management. Mortality rate was 45% and it was in direct correlation with the severity of injury.Conclusion:Grade I and II pancreatic injury can be managed conservatively depending upon the hemodynamic status of the patient. Grade III and IV injuries have a better prognosis if managed surgically.

Curiosity or Underdiagnosed? Injuries to Thoracolumbar Spine with Concomitant Trauma to Pancreas

“…Diagnostically, a CT scan [ 21 , 23 , 26 , 28 ] and laboratory testing [ 29 , 30 ] of pancreatic amylase and lipase are important diagnostic tools; however, both can initially be negative [ 23 , 25 , 27 , 29 ]. Therefore, although concomitant pancreatic injuries might be a curiosity, the underdiagnosis of these concomitant injuries should be minimized, especially in thoracolumbar spine injuries with a severity of AIS 2.…”

“…To make matters worse, pancreatic injuries are initially difficult to detect in computer tomography (CT) scan [ 25 , 26 , 27 , 28 ], which often leads to a delayed diagnosis. Moreover, increases in serum amylase and lipase laboratory parameters, if any, can only be observed a few hours after the injury, [ 27 , 29 , 30 ]. The typical clinical triad of upper abdominal pain, leukocytosis, and elevation of serum amylase levels is rarely pronounced [ 31 ].…”