Outcomes after resection versus non-resection management of penetrating grade III and IV pancreatic injury: A trauma quality improvement (TQIP) databank analysis

Clinical update on management of pancreatic trauma

“…In addition, recent reports from the National Trauma Databank (NTDB) in the USA were identified and reviewed. 5,[17][18][19][20][21][22] Further, a multicentre study in adults 23 and a multicentre study in children 16 and several larger single, dual, or multi-centre cohorts were included. [24][25][26][27][28][29][30][31][32][33][34]…”

“…Based on available studies, there seems to be no benefit in terms of mortality with resection over conservative management, but a decrease in length of stay may be achieved with surgery. 20 A recent paper has summarized the conservative strategies in pancreatic trauma in an acronym, dubbed as the acronym 'SEALANTS' approach 65 based on use of Somatostatin analogues, External drainage, ALternative nutrition, Antacids, Nil per os status, Total parenteral nutrition, and Stenting of the pancreatic duct. The authors suggest that, rather than introducing these in a stepwise fashion, they should be delivered in a 'shotgun' approach, with all elements commenced at once.…”

Epidemiological state, predictive model for mortality, and optimal management strategy for pancreatic injury: A multicentre nationwide cohort study

“…Because the presence or absence of injury to the main pancreatic duct is one of the most important factors affecting outcome after pancreatic injury, it is possible that the optimal management for pancreatic injury grade I/II is different from that for pancreatic injury grade III/IV. However, the current recommendations were made despite no studies showing a statistically significant difference for any single outcome between a conservative and operative treatment strategy [6,28].…”

“…There is recent evidence suggesting that non-operative management can be an acceptable and safe option in patients with pancreatic injury who sustained injury to the main pancreatic duct [28,29]. Previous studies have shown that endoscopic management including pancreatic transpapillary pancreatic duct stenting and sphincterotomy reduces the need for surgery for pancreatic injury by blocking the leaking duct, allowing drainage of pancreatic juice into duodenum, and reducing the inflammatory consequences of extravasation [30,31].…”

Typical Computed Tomographic Images and Operation for Grade IV Pancreatic Injury

“…In this study mortality was 30.0% for grade IV pancreatic injury. Mohseni et al (2) reported mortality of penetrating grade IV pancreatic injuries through trauma quality improvement (TQIP) databank analysis. In this study, The American Association for the Surgery of Trauma (AAST) defines grade IV pancreatic injury as proximal transection to the right of the superior mesenteric vein or parenchymal injury involving the ampulla.…”