The Role of Pancreatogastrostomy Following Pancreatoduodenectomy for Trauma

Delcore, Romano; Stauffer, Jay S.; Thomas, James H.; Pierce, George E.

doi:10.1097/00005373-199409000-00010

Cited by 30 publications

(8 citation statements)

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“…Paramedics transported 10 patients directly to our hospital, and the other 8 patients were transferred from different hospitals because pancreatic injury was detected. The median Injury Severity Score was 22 (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and probability of survival was 0.87 (0.78-0.93).…”

Section: Resultsmentioning

confidence: 99%

“…If the ductal injury was detected in the pancreas head during the surgery or ERCP evaluation, we usually do not aggressively perform pancreatoduodenectomy or any other reconstructive procedures, such as the Letton and Wilson maneuver, because these procedures for severe pancreatic trauma have already been discussed globally with dismal outcomes, and the number of case reports reporting success is still limited. 5,23,24 To decrease and control fluid volume and pressure in the pancreatic main duct, we basically insert an ENPD tube or endoscopic retrograde pancreatic drainage tube if the duct is successfully cannulated at the time of the initial ERCP.…”

Section: Discussionmentioning

confidence: 99%

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How to deploy a uniform and simplified acute‐phase management strategy for traumatic pancreatic injury in any situation

Uchida

Hagawa

Miyashita

et al. 2020

Acute Medicine & Surgery

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Management of traumatic pancreatic injury is challenging, and mortality and morbidity remain high. Because pancreatic injury is uncommon and strong recommendations for pancreatic injury management are lacking, management is primarily based on institutional practices. We propose our strategy of pancreatic injury management. Methods: We retrospectively reviewed patients with pancreatic injury and evaluated our strategy and outcomes. Results: From January 2013 to December 2019, 18 patients were included with traumatic pancreatic injury. The median Injury Severity Score was 22 (25-75% interquartile range, 17-34) and probability of survival was 0.87 (25-75% interquartile range, 0.78-0.93). Patients were grouped according to the American Association for the Surgery of Trauma injury grades: grade I, n = 3 (16.7%); II, n = 6 (33.3%); III, n = 7 (38.9%); and IV, n = 2 (11.1%). All patients underwent endoscopic pancreatic ductal evaluation within 1-2 days after admission. Abbreviated surgery because of hemodynamic instability and subsequent open abdominal management were undertaken in one patient with pancreas head injury and two patients with pancreas body/tail injury. Management was by laparotomy for closed suction drain insertion with main ductal endoscopic drainage in six patients, endoscopic ductal drainage only in six patients, and distal pancreatectomy with closed suction drainage and endoscopic drainage in five patients. One patient with grade I injury underwent observation only. Median length of closed suction drainage was 12 days and that of hospital stay was 36 days. The observed mortality during the study period was 0%. Late formation of pseudo-pancreatic cyst was observed in two patients (11.1%). Conclusion: Our uniform, simplified strategy offers good outcomes for any pancreatic injury site and any concomitant injuries, even in hemodynamically unstable patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

How to deploy a uniform and simplified acute‐phase management strategy for traumatic pancreatic injury in any situation

Uchida

Hagawa

Miyashita

et al. 2020

Acute Medicine & Surgery

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“…For grade III injuries, surgical treatment, such as pancreatic resection, can be selected. In pancreatic head injuries, pancreatoduodenectomy (PD) can be considered [8]. However, as PD may be accompanied by complications after surgery, we should select PD after consideration of the patient’s general condition and the surgical skill of the operator.…”

Section: Discussionmentioning

confidence: 99%

A case of perforation of a pancreatic duct by a pancreatic stent during chemoradiotherapy for pancreatic head cancer: a case report

et al. 2019

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BackgroundPancreatic injuries are rare, and no treatment plan has yet been established for grade III injuries. In many cases, pancreatic stent placement has resulted in saving patients. However, some cases of perforation of a pancreatic duct during the placement of a stent have been described, and there are also a few cases of delayed perforation by a pancreatic stent.Case presentationA 62-year-old man had obstructive jaundice and pancreatitis due to locally advanced pancreatic head cancer. Both biliary and pancreatic stent were placed by endoscopy, after which chemoradiotherapy was performed. Four months later, he visited our hospital with severe abdominal pain. We performed enhanced CT and diagnosed the patient as having a perforation of a pancreatic duct by a pancreatic stent; therefore, we performed an emergency operation. Since we deemed pancreatectomy risky, we inserted pancreatic tubes into both sides of the perforated site and performed percutaneous transgastric drainage. The postoperative course was uneventful. We thereafter cut the tubes and switched to internal drainage.ConclusionMany cases of pancreatic injuries have reported that pancreatic stent placement results in saving the patient, but there have been few cases in which a pancreatic stent causes perforation of a pancreatic duct. External drainage by pancreatic tubes is very effective in resolving perforation of a pancreatic duct.

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“…As most of these procedures will be performed on normal caliber common bile ducts, we recommend placement of a Silastic tube through the choledochojejunostomy to stent the repair. Although examples can be found in the literature of modifications of the standard trauma such as pancreaticogastrostomy [17] and sparing of the pylorus [18], we prefer a standard reconstruction. A recent report of a two-stage pancreaticoduodenectomy in which the stages were performed 72 hours apart underscores the importance of performing this procedure in a hemodynamically stable, well-resuscitated patient [19].…”

Section: Cost Effectiveness Unknownmentioning

confidence: 99%

Pancreatic trauma: Diagnostic and therapeutic strategies

Phelan¹,

Minei

2005

Curr Treat Options Gastro

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The management of pancreatic trauma provides trauma surgeons with diagnostic and therapeutic challenges. The two most important facts that must be established are the location of the injury in relation to the superior mesenteric artery and vein and the status of the main pancreatic duct. If a pancreatic injury is discovered at the time of exploration and no main ductal injury is found, debridement and wide drainage are adequate therapy regardless of the location of the injury. If the status of the duct cannot be confidently determined and the injury lies to the left of the vessels, a single attempt at cholecystocholangiography should be performed. If this is unsuccessful, distal pancreatectomy with splenectomy with no further attempts at ductal imaging are our treatments of choice. Splenic salvage may be considered in the pediatric population. If the injury lies to the right of the vessels and the status of the duct is not able to be diagnosed with thorough exploration, we recommend endoscopic retrograde cholangiopancreatography (ERCP), either intraoperatively or on an urgent basis postoperatively, with wide closed suction drainage prior to closure of the abdomen. If the ERCP shows intact pancreatic and common bile ducts, expectant management is warranted. If the duct is injured, the patient is returned to the operating room for debridement of the injury, oversewing of the proximal pancreatic duct, and a distal pancreaticojejunostomy. Use of ERCP to stent this injury type has been reported but has yet to be rigorously studied. If the ampulla is destroyed or the pancreatic head is devascularized, pancreaticoduodenectomy is required either at the original surgery or after patient stabilization if damage control laparotomy is necessary. If a stable trauma patient has findings on a computed tomography suggestive of an isolated pancreatic injury, we still recommend laparotomy using the previously mentioned algorithm. All patients with pancreatic injury should have feeding access placed intraoperatively beyond the ligament of Treitz, with our choice being a nasal-jejunal feeding tube. Postoperative pancreatic fistulae should be managed with adequate closed suction drainage, octreotide, and observation for a period of at least 4 to 8 weeks prior to contemplation of surgical intervention.

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The Role of Pancreatogastrostomy Following Pancreatoduodenectomy for Trauma

Cited by 30 publications

References 0 publications

How to deploy a uniform and simplified acute‐phase management strategy for traumatic pancreatic injury in any situation

How to deploy a uniform and simplified acute‐phase management strategy for traumatic pancreatic injury in any situation

A case of perforation of a pancreatic duct by a pancreatic stent during chemoradiotherapy for pancreatic head cancer: a case report

Pancreatic trauma: Diagnostic and therapeutic strategies

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