Pancreatic Trauma in the Adult: Current Knowledge in Diagnosis and Management

Chrysos, Emmanuel; Athanasakis, Elias; Xynos, Evaghelos

doi:10.1159/000065084

Cited by 49 publications

(46 citation statements)

References 132 publications

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“…El TAC abdominal es la prueba de elección para detectar lesiones parenquimatosas en una fase precoz (4). La resonancia magnética nuclear y la colangiografía retrógrada endoscópica son de utilidad para determinar la integridad del conducto pancreático principal (3,6). La evolución natural es a la resolución espontánea en el 60% de los casos por lo que se acepta universalmente que el tratamiento de elección del pseudoquiste no complicado es la observación y seguimiento radiológico durante 6-8 semanas (1-6).…”

Section: Discussionunclassified

Pseudoquiste traumático de páncreas

Franco

Benítez

Almudí

et al. 2007

Rev. esp. enferm. dig.

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Section: Discussionunclassified

Pseudoquiste traumático de páncreas

Franco

Benítez

Almudí

et al. 2007

Rev. esp. enferm. dig.

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“…Occasionally in a relatively stable patient, pancreaticoduodenectomy with or without reconstruction may be a valid option, but the mortality rate in an emergency situation is high and may exceeded 30% [37,38]. The main factors responsible for such high morbidity and mortality rates are the associated pancreatitis, a soft and friable pancreas and an undilated normal sized pancreatic duct [3,39,40].…”

Section: Combined Pancreaticoduodenal Injuriesmentioning

confidence: 99%

Management of Pancreaticoduodenal Injuries

Sharma

2011

Indian J Surg

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The nature of the pancreatic or duodenal injury itself influences mortality, and is co-dependent on the presence of multiple other injuries, which account for most of the early mortality. Intra-abdominal sepsis leading to multiple organ failure accounts for most of the late deaths, indicating the importance of early haemodynamic stabilization, adequate debridement of devitalized tissue and wide drainage. Most duodenal injuries can be adequately managed with primary repair or resection and anastomosis. The presence of a pancreatic injury certainly increases the likelihood of an anastomic leak from a duodenal repair. With a significant associated pancreatic injury a more conservative initial approach to the duodenal injury may be more appropriate. Pancreatic injuries should be treated by debridement and simple drainage unless there is clinically obvious duct involvement. For distal injuries with duct involvement, a distal pancreatectomy is indicated. In injuries to the pancreatic head with clinical duct involvement, complex procedures such as pancreaticoduodenectomy should not be performed in the unstable patient with multiple injuries. Debridement and wide external drainage may be implemented and the resulting fistula dealt with at a later operation, if necessary. Large, complex, combined pancreaticoduodenal injuries may require temporary duodenal ligation or a pancreaticoduodenectomy and subsequent reconstruction.

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“…2 saat sonra ölçülen değerin daha da artmış (503 IU/L )olduğunun görülmesi, pankreas yaralanması şüphesini artırdı. Pankreas travmalı hastaların yaklaşık %80' inde serum lipaz değerlerinin yükseldiği tespit edilmiştir, ancak bu hastalarda, serum amilaz düzeyleri de yüksek tespit edildiğinden, rutin olarak serum lipaz düzeyleri istenmesine gerek yoktur, sadece serum amilaz düzey-lerinin görülmesi yeterlidir (10) . Bundan dolayı, bu olgumuzda serum lipaz düzeylerine bakmayı gerek duymadık.…”

Section: Akatos 2011;2(2):28-30 Jaemcr 2011;2(2):28-30unclassified

“…Bu bulgunun başlangıçta hastanın şikâyetlerini, fizik muayene bulgularını açıklayabileceği düşünülse de artmış serum amilaz düzeyleri, klinik şüphemizin artmasına ve batın tomografisi planlamamızda yol gösterici olmuştur. Bunun yanında; pankreas yaralanmalarının yaklaşık % 40' ında, ilk 12 saat içinde çekilen BT' de pozitif bulgu saptanmayabileceğinin bilinmesi, 24-48 saat sonra kontrol BT' ye ihtiyaç duyulabileceğinin bilinmesi önemlidir (8,10) . Sonuç olarak İzole künt pankreas yaralanması oldukça nadir görülen bir durumdur.…”

Section: Akatos 2011;2(2):28-30 Jaemcr 2011;2(2):28-30unclassified

ï¿½solated Blunt Pancreas ï¿½njury in Handball Match

Dilmen¹,

Acar²,

Çınar³

et al. 2011

JAEMCR

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ıntroduction: Pancreas is a rare injured after blunt abdominal traumas. Because, It is a retroperitoneal and other organs in front of pancreas, usually absorb pancreatic trauma. Isolated pancreatic injury is rate of % 5-10 and can occur in sports traumas where close contact and profound impact can be made. Case report: A 23 years old man was admitted to emergency department with abdominal pain, nausea and vomiting. He had received a blow to the epigastric region of abdomen, during a handball match four hours ago. Vital signs were stable and in his physical examination no abdominal movements were present while breathing. Intestinal sounds were hyperactive and there was a rigid abdomen with rebound and tenderness in all four quadrants. In abdominal ultrasonography it was reported that there was no emergency sonografic pathology, except a rectus sheath hematoma. As the initial serum amylase level was 398 U/L and after two hours in second control was further elevated 503 U/L, a contrast enhanced (oral-intravenous) abdominal computed tomography was performed. There was a hematoma in the head of pancreas, circum uncinat process. The patient admitted to hospital with the diagnosis of isolated blunt pancreatic injury. result: In patients with sport traumas to abdominal region, isolated pancreatic injuries must be considered. Serial amylase level measurements can be helpful to diagnose this life threatening condition but for certain diagnosis, Computed tomography evaluation must be necessary. İzole pankreas yaralanması % 5-10 civarında olup, yakın temas gerektiren, şiddetli çarpışmaların yaşanabileceği spor yaralanmalarında, nadiren de olsa karşımıza çıkabilir. Olgu Sunumu: Hentbol maçındayken, epigastrik bölgesine darbe alan 23 yaşında erkek hasta, karın ağrısı, bulantı, kusma şikayetleriyle olayın 4. saatinde acil servisimize başvurdu. Hasta geldiğinde vital bulguları stabildi, fizik muayenesinde; inspeksiyonda batın solunuma katılmıyor, dinlemekle barsak sesleri hiperaktif, palpasyonda tüm kadranlarda hassasiyet, defans ve rebaund mevcuttu. Yapılan batın ultrasonunda; rektus abdominis kas hematomu haricinde, acil sonografik patoloji saptanmadı. Yapılan laboratuar tetkiklerinde; serum amilaz düzeyinin 398 U/L saptanması; iki saat sonra yapılan kontrollerde 503 U/L saptanarak, daha da yükselmesi sonucunda, hastada IV/oral kontrastlı batın tomografisi planlandı. Pankreas başında, uncinat processin etrafında hematom saptanan hasta, izole künt pankreas yaralanması tanısıyla hastaneye yatışı yapıldı. Sonuç: Abdominal bölgeye olan spor travmaları sonrası izole pankreas yaralanmaları olabileceği akılda tutulmalıdır. Bu hayatı tehtid eden durumun tanısında; seri yapılan serum amilaz ölçümleri faydalıdır, fakat kesin tanı için mutlaka bilgisayarlı tomografiyle evaluasyon gereklidir.

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Pancreatic Trauma in the Adult: Current Knowledge in Diagnosis and Management

Cited by 49 publications

References 132 publications

Pseudoquiste traumático de páncreas

Pseudoquiste traumático de páncreas

Management of Pancreaticoduodenal Injuries

ï¿½solated Blunt Pancreas ï¿½njury in Handball Match

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