Endoscopic ultrasound-guided transmural drainage of post-traumatic pancreatic fluid collections

Abstract

Background Pancreatic injury is an uncommon consequence of abdominal trauma, and surgery has been the conventional treatment. The role and timing of endoscopic ultrasound (EUS)-guided treatment of the consequences of traumatic pancreatic injury is unclear. Our study evaluated the safety and efficacy of EUS-guided transmural drainage of post-traumatic pancreatic fluid collections (PFC). Methods A retrospective analysis of 13 patients (mean age 20.2±4.4 years; 12 males) with post-traumatic PFC treated with EUS-guided transmural drainage over the last 10 years was performed. Patient demographics, imaging findings, size of PFC, details of endoscopic transmural drainage procedure, outcome details, as well complications were retrieved from our database. Results The patients underwent drainage at 26.8±7.4 days after abdominal trauma, and the mean size of PFC was 11.8±3.2 cm with 2 patients having multiple fluid collections. Ten patients had PFC with a well-formed wall and 3 patients had an incompletely formed wall. Endoscopic drainage was technically successful in all 13 patients and 11 patients underwent transmural drainage with multiple plastic stents whereas 2 patients were treated with lumen apposing metal stents. The PFC resolved in all patients over a mean period of 2.7±0.4 weeks. One patient developed gastrointestinal bleeding 6 days after the procedure, successfully treated with angio-embolization. Conclusion EUS-guided transmural drainage of post-traumatic PFC is safe and effective and can be safely performed at an early phase (<4 weeks) after pancreatic trauma.

A Distinct Paradigm in the Management of Pancreatic Trauma

“…Historically, grade I-II injuries were conservatively managed as undisputed standard of care [2][3][4]. However, debate ensued with grade III-V traumas as early opinion dictated immediate surgical drainage or resection [1,2,11].…”

“…With the advance of imaging-guided intervention, non-operative management has been trialled with favourable outcomes [3][4][5][6]. We present a case series of 6 paediatric and 1 adult patient with traumatic MPD disruption and subsequent novel management of peripancreatic collections with endoscopic ultrasoundguided (EUS) transmural drainage.…”