Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?

Antonacci, Nicola; Saverio, Salomone Di; Ciaroni, Valentina; Biscardi, Andrea; Giugni, Aimone; Cancellieri, Francesco; Coniglio, Carlo; Cavallo, Piergiorgio; Giorgini, Eleonora; Baldoni, Franco; Gordini, Giovanni; Tugnoli, Gregorio

doi:10.1007/s00534-010-0329-6

Cited by 54 publications

(56 citation statements)

References 16 publications

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“…There are wide-ranging disparities in the reported overall postoperative morbidity rates after pancreatic injuries due to non-standardised analyses and a lack of comprehensive datasets which specifically document outcome after resection of complex pancreatic injuries[3-5]. The absence of an appropriate and defined methodology to measure and register peri-operative outcome, precludes the generation of validated outcome data, fundamental to accurate benchmarking of surgical performance and internal quality control[6].…”

Section: Introductionmentioning

confidence: 99%

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

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AIMTo benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.METHODSA prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.RESULTSOverall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant.CONCLUSIONThis ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

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Section: Introductionmentioning

confidence: 99%

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Jonas¹,

Thomson²,

Kotze³

et al. 2017

WJGS

View full text Add to dashboard Cite

show abstract

“…In a series of 55 patients with pancreaticoduodenal injury (85% resulting from blunt trauma), 69% were found to have isolated pancreatic injury, and 11% had combined injuries to the pancreas and the duodenum. Associated injury (other than the duodenum) was present in 55% of the patients, with the spleen, liver and abdominal vessels being the most common [6]. In a pediatric series of 31 patients, 18 (58%) had associated abdominal injuries; 7 (23%) had splenic injury, 6 (19%) liver injury and 5 (16%) injury to the duodenum [10].…”

Section: Introductionmentioning

confidence: 91%

“…Even if the reported overall morbidity rate in patients with an intact pancreatic duct is between 60% and 75% [3,6,11], specific pancreatic related morbidity is lower [3,24]. As can be expected, morbidity rate is higher in patients with a higher grade of pancreatic injury [3,6], especially if the pancreatic injury is associated by injury to the duodenum [6,[43][44][45]. The most common complications of blunt pancreatic trauma are fistula formation which occurs in up to 20% [3], intraabdominal abscesses in 20-25% [11], pancreatitis in 10% [3] and pseudocyst in 3% [3].…”

Section: Morbiditymentioning

confidence: 98%

“…In earlier literature, only about 30% of injuries to the pancreas resulted from blunt abdominal trauma [4,5]. In more recent published series, blunt trauma constitutes between 63-96% of all pancreatic trauma [6][7][8][9]. As most reports include both blunt and penetrating pancreatic injuries, the exact frequency of associated abdominal injuries after blunt trauma is difficult to obtain.…”

Section: Introductionmentioning

confidence: 97%

“…Today mortality rates after blunt pancreatic trauma remain high with a reported frequency between 5% and 25% [3,6,11,14]. Patients with associated injuries are at higher risk of death than those with isolated pancreatic injury [3,6,9,15].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Early endoscopic treatment of blunt traumatic pancreatic injury

Björnsson

Kullman

Gasslander

et al. 2015

Scandinavian Journal of Gastroenterology

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Blunt pancreatic trauma is a rare and challenging situation. In many cases, there are other associated injuries that mandate urgent operative treatment. Morbidity and mortality rates are high and complications after acute pancreatic resections are common. The diagnosis of pancreatic injuries can be difficult and often requires multimodal approach including Computed Tomography scans, Magnetic resonance imaging and Endoscopic retrograde cholangiopancreaticography (ERCP). The objective of this paper is to review the application of endoprothesis in the settings of pancreatic injury. A review of the English literature available was conducted and the experience of our centre described. While the classical recommended treatment of Grade III pancreatic injury (transection of the gland and the pancreatic duct in the body/tail) is surgical resection this approach carries high morbidity. ERCP was first reported as a diagnostic tool in the settings of pancreatic injury but has in recent years been used increasingly as a treatment option with promising results. This article reviews the literature on ERCP as treatment option for pancreatic injury and adds further to the limited number of cases reported that have been treated early after the trauma.

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Surgical management and outcome of civilian gunshot injuries to the pancreas

Chinnery

Krige

Kotze

et al. 2011

British Journal of Surgery

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Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?

Abstract: Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures.

Cited by 54 publications

References 16 publications

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Resection of complex pancreatic injuries: Benchmarking postoperative complications using the Accordion classification

Early endoscopic treatment of blunt traumatic pancreatic injury

Surgical management and outcome of civilian gunshot injuries to the pancreas

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