Predictors of successful non-operative management of grade III &amp; IV blunt pancreatic trauma

Koganti, Suman B; Kongara, Ravikanth; Boddepalli, Sateesh; Naushad, Shaik Mohammad; Thumma, Venu Madhav; Bheerappa, Nagari; Sastry, R A

doi:10.1016/j.amsu.2016.08.003

Cited by 29 publications

(31 citation statements)

References 42 publications

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“…Endoscopic and percutaneous interventions such as ERCP with pancreatic stent and/or sphincterotomy or percutaneous aspiration and drain placement for pancreatic duct injury have been reported in patients with class II and III PI (AAST-OIS grades III and IV–V) with success rates of 68–94% with or without the octreotide administration [15, 201–208]. However, some concerns exist regarding increased rates of pancreatic duct stricture [209].…”

Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

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Section: Methodsmentioning

confidence: 99%

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

et al. 2019

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“…When ERCP does not show ductal injury (AAST-OIS grad II and JAST type IIIa), nonsurgical conservative management is recommended [4] . In addition, we propose conservative treatment with ENPD for deep parenchymal injury without ductal injury to avoid the development of complications such as pancreatic pseudocysts [1], [5] , although further studies involving more patients are needed to confirm the efficacy and safety of this approach.…”

Section: Discussion and Proposal For Algorithm For Management Of Pancmentioning

confidence: 99%

“…Pancreatic trauma is rare among solid organ injuries, especially when compared with hepatic and splenic injuries [1] , and is considered to occur in 2% to 16% of patients with abdominal trauma [2], [3] . Pancreatic trauma is potentially lethal, and its mortality increases when severe complications such as main pancreatic duct injury and/or combined vascular injury are involved [4]- [6] .…”

Section: Introductionmentioning

confidence: 99%

“…Pancreatic trauma is potentially lethal, and its mortality increases when severe complications such as main pancreatic duct injury and/or combined vascular injury are involved [4]- [6] . Despite improvements in surgical techniques and conservative management, the overall mortality of pancreatic trauma remains high, ranging from 10% to 20% [1], [5], [7], [8] .…”

Section: Introductionmentioning

confidence: 99%

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Pancreatic Trauma: Proposal for Management Algorithm

Hashimoto

Yamamoto

Yamaki

et al. 2020

International Surgery

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IntroductionPancreatic trauma is potentially lethal despite recent improvements in surgical techniques and conservative management. However, no guidelines for the management of pancreatic trauma have been established. In this report, we propose an algorithm for the management of pancreatic trauma based on our experience of nine cases and a literature review.Case presentationThis study included nine patients with pancreatic trauma (five men and four women). The patients’ median age was 40 years (range, 17–75 years). The overall mortality rate was 22.2%, and the postoperative mortality rate was 16.7%. Superficial trauma was present in two patients. Deep trauma without injury to the main pancreatic duct was present in one patient, and this patient was treated successfully with endoscopic nasopancreatic drainage. Active bleeding was present in two patients and controlled by interventional radiology. Deep trauma with injury to the main pancreatic duct was present in six patients. Among them, one patient died after conservative treatment with endoscopic nasopancreatic drainage. The other five patients underwent surgery (pancreatic resection in four and necrosectomy in one).ConclusionThe herein-described algorithm recommends interventional radiology for active arterial bleeding, conservative management for trauma without ductal injury, and surgery for trauma with ductal injury. This algorithm may provide a basis for future establishment of guidelines.

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“…The management of high grade fractures (III IV) has long been debated; latest published data tend to underline the value of conservative treatment, even if a pancreatic duct rupture is associated. Reports in favor of early emergency surgery management with ductal rupture argue that this attitude considerably reduces the occurrence of recurrences [20][21][22] which has been estimated to be around 40%.…”

Section: Rationale For Treatment and Evidence-based Literaturementioning

confidence: 99%