The current management of pancreatic trauma

Abstract

ticentre trials are warranted to ascertain strict criteria and evaluate the current recommendations.

Outcomes after Distal Pancreatectomy for Trauma in the Modern Era

“…P ANCREATIC INJURY OCCURS in approximately 2 to 4 per cent of cases after overall abdominal trauma; 5 per cent of cases after blunt abdominal injury, and 6 per cent after gunshot wounds to the abdomen. [1][2][3] Management is often challenging in these patients because of concomitant intra-abdominal injuries in 90 per cent of cases, leading to substantial rates of morbidity and mortality. This is largely due to the close proximity of the pancreas to other major organs and vessels, including duodenum, stomach, liver, common bile duct, spleen, renal vessels, superior mesenteric vessels, and inferior vena cava (IVC).…”

“…[5][6][7] Management guidelines for pancreatic injury rely predominantly on the classification system established by the American Association for the Surgery of Trauma, particularly taking into account damage to the main pancreatic duct (Table 1). 2,8,9 According to guidelines and associated studies, distal pancreatectomy (DP) becomes the mainstay of management when injury includes both parenchymal and major ductal involvement proximal to the superior mesenteric artery vessels (grade III injury). 2,10 Importantly, prompt evaluation is essential, as poor prognosis is associated with delay in diagnosis, in addition to the grade of injury.…”

“…2,8,9 According to guidelines and associated studies, distal pancreatectomy (DP) becomes the mainstay of management when injury includes both parenchymal and major ductal involvement proximal to the superior mesenteric artery vessels (grade III injury). 2,10 Importantly, prompt evaluation is essential, as poor prognosis is associated with delay in diagnosis, in addition to the grade of injury. [11][12][13] Even with proper management, complication rates remain high after DP occurring in 30 to 60 per cent of patients, and most commonly include postoperative pancreatic fistula (POPF).…”