Intraoperative ultrasonography is useful for diagnosing pancreatic duct injury and adjacent tissue damage in a patient with penetrating pancreas trauma

Abstract

We report a case of pancreatic injury, caused by a stab wound, in which ductal injury and wound depth were clearly identified by intraoperative ultrasonography. A 65-year-old woman was emergently admitted to our hospital after stabbing herself in the abdomen in a suicide attempt. Preoperative computed tomography (CT) and laboratory examination revealed liver and pancreatic injury with massive abdominal bleeding and free air. Operative findings included injuries of the stomach, small bowel, colon, liver, and pancreas. The pancreatic lacerations were 1 cm in length, in the body. Intraoperative ultrasonography enabled the diagnosis of a lacerated main pancreatic duct with no damage to the major vessels posterior to the pancreas. Distal pancreatectomy; simple repairs of the liver, small bowel, and stomach; exteriorization of the injured colon; cholecystostomy; gastrostomy; and jejunostomy were performed. The patient recovered and was transferred to a psychiatric hospital 87 days after surgery. In this patient, intraoperative ultrasonography was successfully used to identify the degree of injury to the pancreatic duct, as well as the depth of the stab wound. In conclusion, intraoperative ultrasonography should be routinely performed to detect main pancreatic duct injury in penetrating pancreatic trauma.

Blunt pancreatic trauma: A Western Trauma Association critical decisions algorithm

“…Indeed, Schellenberg et al 39 reported a series in which 94% of patients were managed based on visual inspection alone; 6% had intraoperative pancreatography, and the studies were all inconclusive. Intraoperative ultrasound has gained popularity in recent years by trauma and hepatobiliary surgeons, allowing for an efficient and highly sensitive method to evaluate the MPD 40–42 …”

“…Intraoperative ultrasound has gained popularity in recent years by trauma and hepatobiliary surgeons, allowing for an efficient and highly sensitive method to evaluate the MPD. [40][41][42] E. Treatment: The American Association for the Surgery of Trauma Organ Injury Score is relevant to the management of BPI. Grades I and II (i.e., low grade) injuries are contusions and lacerations that spare the pancreatic duct.…”

Multidisciplinary Diagnosis and Management of Pancreatic Trauma

“…25 Intraoperative ultrasound is useful for detecting both pancreatic parenchymal and ductal injury. 26 If these techniques do not reveal injury and suspicion remains high, cholangiopancreatography can be performed 27 ; if the patient is on an angiography table, on-table ERCP or open cholangiopancreatography (e.g., via the gallbladder, transduodenal if duodenal injury is present) can be performed. Alternatively, a damage control strategy can be employed by widely draining the injury, closing the abdomen either primarily or temporarily, caring for the patient in the intensive care unit, and obtaining additional diagnostic data with MDCT, MRCP, or ERCP depending on degree of suspicion and the patient's physiological status.…”

Pancreatic Trauma Revisited*

“…Intraoperative pancreatography, which will be discussed later in the section on ductal transection, may be used to locate an injury to the main pancreatic duct [13]. Intraoperative ultrasound (IOUS) can also be used to diagnose a parenchymal or ductal laceration [15].…”