Management of pancreatic trauma: a literature review

Petrone, Patrizio; Álvarez, Sara Moral; Pérez, Marta González; Esparragón, José Ceballos; Marini, Corrado P.

doi:10.1016/j.cireng.2016.05.012

Cited by 14 publications

(22 citation statements)

References 39 publications

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“…Two third of our patients was haemodynamicaly unstable, factor that greatly predict associated other organ injury, and determine the neces-sity for immediate surgery. Pancreatic injury in isolation was a rarity in our study account for only 10%, igure which greatly coincide with most published literatures (Petrone et al, 2017;Abed and Salim, 2019;. More commonly pancreatic injury is part of multiple injuries involving more than one organ, in the present study other abdominal organ injury was very frequent including solid organs , viscera particularly the duodenum and vascular injury these results were comparable with the results Vasquez et al and Memon et al (Salim and Abed, 1926;Ewaid et al, 2020).…”

Section: Resultssupporting

confidence: 89%

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The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

Tamimi

Kadhm

2020

ijrps

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The pancreas is a long J-shaped, soft, lobulated retroperitoneal organ. Pancreatic injury is relatively uncommon, occurring in 0.2–2 % of all trauma patients and 3–12 % of patients with abdominal injury. All traumatic pancreatic injuries are associated with significant morbidity with an overall rate of morbidity nearing 40%, higher grade pancreatic injuries are associated with higher rates of morbidity and mortality . To evaluate of surgical management of blunt and penetrating pancreatic trauma. During the period from January 2015 to September 2018, thirty patients with blunt and penetrating abdominal trauma were managed in emergency surgical department in Al-Diwaniya Teaching Hospital and assigned in prospective a case control study. Patients with proved associated pancreatic injury (regardless of the degree) at the time of laparotomy were included in the study . The mean age of patients was 34.4 year (17- 57 years) among them there was 25 male (83.3 %) and 5 females (16. 7% The overall mortality rate is 20% (6 patients). The predominant mechanism of injury was penetrating 24 patients (80%) from gunshots and 6 patients with blunt abdominal trauma resulted from road traffic accidents). Pancreatic injury is infrequent in abdominal trauma. Its frequency is little different between blunt and penetrating abdominal trauma.

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Section: Resultssupporting

confidence: 89%

“…Menahem t al stated that the majority of pancreatic injury were caused by blunt abdominal trauma in European nations mostly due to road traf ic acci- (Taggar and Coleman, 2016). This is not the case in countries with non strict legalization of irearms like the united states (Davis et al, 1976;Young et al, 1998;Petrone et al, 2017) .…”

Section: Resultsmentioning

confidence: 99%

The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

Tamimi

Kadhm

2020

ijrps

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“…Our morbidity and mortality rates are in agreement with the available literature, which shows similar or higher morbidity and mortality, particularly with increasing injury grades and hemodynamic instability. 2,7,11,31 Among the limitations of this study is the relatively small number of patients. Likewise, lack of interventional management using pancreatic duct stenting could have avoided the need of surgical intervention in a substantial number of patients.…”

Section: Discussionmentioning

confidence: 95%

Surgical management of traumatic pancreatic injuries and their consequences.

El‐Badry

Ali

2020

Int Surg J

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Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.

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“…The incidence of PF observed in study conducted by Petrone et al was 11%. 34 According to the experience of Young et al more PF occur during management with only drainage than after procedures with resection. 40 Major ductal injury is the principal determinant of outcome for patients with pancreatic trauma.…”

Section: Discussionmentioning

confidence: 99%

“…31 Out of the 12 patients who were analyzed in our study most of the patient (n=10) (83.3%) had blunt trauma to the abdomen as the most common mode of injury leading to pancreatic duct injury which is concurrent with the study conducted by Menahem et al, Wisner et al 32,33 In the review conducted by Petrone et al, the mechanism of injury in 1236 cases reviewed: 59.8% were due to a blunt mechanism, and 40.2% a penetrating mechanism which is concurrent to our study similarly in the study conducted by Ragulin et al blunt trauma abdomen was the most common mode of injury. 34,31 In the cases where diagnosis and treatment are delayed >24 h, mortality increases to 40% as compared with 11% for those diagnosed <24 h. Two-thirds of the patients who survive more than 48 hours end up with complications, and 37% of deaths are late and are related to complications such as fistula, abscess, anastomotic breakdown, pancreatitis, pseudocysts and pneumonia. 35,36 There has been a significant change in the approach to the management of pancreatic injuries from complex procedures and towards simple drainage.…”

Section: Discussionmentioning

confidence: 99%

Step up approach for the management of late presentation of pancreatic trauma patients

et al. 2020

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Background: Pancreatic injuries are usually subtle to identify by different diagnostic imaging modalities and these injuries are often overlooked in cases with extensive multi-organ trauma. Our study was conducted to evaluate the outcome of a step-up approach in the management of pancreatic trauma patients with late presentation.Methods: The study included 15 patients who presented with grade III AAST delayed presentation of pancreatic trauma from September 2017 to 2019. In our step-up approach 2 staged procedure was done, firstly laparotomy with necrosectomy along with closure of proximal pancreatic duct with external drainage of pancreatic duct, in second stage Roux-en-Y pancreaticojejunostomy was done to drain the remnant pancreas as a definitive procedure 3 to 6 months after initial procedure.Results: In our study, blunt trauma abdomen (83.30%) (n=10) was the most common mode of injury. The main reason for delay in diagnosis of pancreatic trauma was delayed presentation of patient (83.3%) (n=10). Total of 4 patients were admitted to intensive care unit (ICU) at the time of admission. 10 patients underwent both the stages of step up approach management among which one patient had pancreatic fistula as a complication (n=1) (10%) and one patient had post-operative abscess as a complication (n=1) (10%). No mortality was noted in our study.Conclusions: The step-up approach discussed above proves to be beneficial towards management of patients with delayed presentation of pancreatic trauma in our setting.

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Management of pancreatic trauma: a literature review

Cited by 14 publications

References 39 publications

The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

The Incidence and Surgical Approaches of Pancreatic Injuries Following Blunt and Penetrating Abdominal Trauma in Al-DiwaniyahTeaching Hospital

Surgical management of traumatic pancreatic injuries and their consequences.

Step up approach for the management of late presentation of pancreatic trauma patients

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