Non-operative management of a grade IV pancreatic injury

Abstract

Isolated pancreatic transection with ductal disruption in blunt abdominal trauma is extremely rare. We report the case of a 14-year-old boy who suffered pancreatic transection at the junction of body and head of the pancreas; yet remarkably recovered after initial conservative management. He was periodically examined clinically and underwent regular abdominal ultrasonography. Nearly 6 months later, endoscopic retrograde cholangiopancreatography with pancreatic duct stenting, pancreatic sphincterotomy and cystogastrostomy for the pseudocyst diagnosed during the follow-up period was performed. Acute surgical management of pancreatic transection is fraught with high mortality and morbidity. Through this effort, we highlight the successful role of non-operative management of a haemodynamically stable patient with grade IV pancreatic injury, thereby avoiding radical surgery in the acute stage and preserving exocrine and endocrine function.

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

“…The ERCP may play a role in duodeno-pancreatic trauma in order to avoid late-diagnosis and/or treatment both in adult and pediatric patients [10, 15, 41–43, 48–52, 58–60, 62–64, 67, 68, 70, 76–78, 90, 97, 101, 127–149]. It is an invasive procedure with 3–14% risk of post-procedure pancreatitis and 0.2–1% mortality rate [6, 10, 11, 40, 41, 45, 49, 51–53, 58, 61–64, 67, 68, 70–72, 75, 77, 78, 97, 128, 130, 133, 134, 137–140, 142, 144, 146, 148–157]. Moreover, in suspected duodenal perforations, the ERCP is not recommended.…”

“…CT-scan is usually the first-line imaging tool in the assessment of late complications of pancreatic trauma and very useful in driving management [39, 61, 71, 72, 76, 96, 135, 145, 233, 247, 248]. MRI is a reliable alternative to CT-scan in children and pregnant women [40, 45, 52, 97, 249, 250].…”

“…US or CEUS is used as an alternative to CT for follow-up of fluid collections, pseudocysts, and pancreatic disruptions after pancreatic trauma mainly in children or in low-resource settings [16, 26, 40, 45, 49, 53, 55, 63, 71, 75, 78, 133, 134, 138, 245, 247, 251–254]. CEUS may improve results of pancreatic imaging, being nearly as accurate as CT-scan and reducing radiation exposure in children [249, 255, 256].…”

Grade IV traumatic pancreatic injury with primary duodenum malignant lymphoma following pancreatoduodenectomy: a case report

“…Because the method cannot be easily selected, the probability of postoperative complications due to pancreatic resection or anastomosis in a pancreatic injury is as high as 40% [10]. Recently, some reports have suggested that NOM using endoscopic pancreatic duct stenting could be a useful and safe option in selected patients [11]. In this case, we selected PD because we suspected a coexisting duodenal injury.…”

Blunt abdominal trauma. Pancreatic injury. Part 4

“…Миниинвазивное лечение в ранние сроки после травмы, если оно возможно, улучшает результаты консервативной терапии и уменьшает частоту специфических осложнений [60,108,109,110], к которым относятся травматический панкреатит [12,20,25,26], парапанкреатическая киста [1,56,66,11,111], наружный панкреатический свищ [1,112,113], стеноз панкреатического протока [114], внутрибрюшной абсцесс [30,115]. Отдаленные результаты эндоскопического лечения пока не всегда удовлетворительные [114].…”