Management of Blunt Major Pancreatic Injury

Abstract

The complication rate for our cases of blunt major pancreatic injury was high (62.2%), especially when treatment was delayed more than 24 hours; the same result was also noted for cases transferred from other institutions. Distal pancreatectomy with spleen preservation had a lower complication rate (22.2%) compared with other procedures and is suggested for grade III and grade IV injuries. Magnetic resonance pancreatography was unreliable early after injury but was effective in the chronic stage. Although pancreatic duct stenting can be used to treat posttraumatic pancreatic fistula and pseudocyst, the major duct stricture in the chronic stage of recovery and the risk of sepsis in the acute stage must be overcome.

Blunt trauma pancreas

“…The spectrum of injuries ranges from minor contusions to massive disruption of the pancreatic. 5 In addition, pancreatic injuries rarely occur by themselves and are often associated with other intra-abdominal injuries, such as those of the liver, duodenum and major vessels. 6 Due to retroperitoneal location of the organ, symptoms and signs of pancreatic trauma are subtle making diagnosis more difficult and easily missed.…”

“…5 A study from Taiwan showed that Distal Pancreatectomy is a superior operative treatment for distal injuries when compared to pancreaticojejunostomy, which had a high complication rate of 60% due to anastomotic leakage. 5 While an attempt at splenic preservation in stable patients is an option, this task IJBAR (2013) 04 (08) www.ssjournals.com too time-consuming with no proven benefit in the adult trauma setting. In addition, the extensive inflammation encountered in cases of delayed treatment, makes this even more difficult and is a commonly cited reason for performing splenectomy.…”

Spleen preserving distal pancreatectomy in an isolated blunt pancreatic trauma

“…In addition, its diagnosis can be difficult; physical signs may be poor and laboratory findings nonspecific [1] , resulting in delayed treatment [3] . In many instances, the injury only becomes apparent after the development of complications [4] .…”

“…Due to this, the management of these kinds of injuries is not easy and few surgeons and institutes have the necessary experience [1] . Several treatment modalities have been described, from non-surgical to open drainage and even duodenopancreatectomy [3] , depending on the grade of the lesion. Major duct injury is the most important factor related to the outcome in these patients [3] .…”

“…Several treatment modalities have been described, from non-surgical to open drainage and even duodenopancreatectomy [3] , depending on the grade of the lesion. Major duct injury is the most important factor related to the outcome in these patients [3] . When present (incidence near to 1.3%), pancreaticojejunostomy and distal pancreatectomy (DP), with or without splenectomy, can be performed, the latter being preferred [3] .…”