Surgical management of pancreatic trauma in Australia

Aldridge, Oscar; Leang, Yit; Soon, David Sien Chin; Smith, Marty; Fitzgerald, Mark; Pilgrim, Charles

doi:10.1111/ans.16498

Cited by 8 publications

(5 citation statements)

References 26 publications

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“…Our morbidity and mortality rates are consistent with previous reports from the United Kingdom[ 14 ], Asia[ 15 ], and Australia[ 16 ]. This is likely due to the predominance of blunt injuries (11/14), with penetrating trauma comprising a minority of cases in this series (3/14).…”

Section: Discussionsupporting

confidence: 92%

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

Chui¹,

Kotecha²,

Gall³

et al. 2023

World J Gastrointest Surg

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BACKGROUND The management of high-grade pancreatic trauma is controversial. AIM To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries. METHODS A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified. RESULTS Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies. CONCLUSION We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.

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Section: Discussionsupporting

confidence: 92%

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

Chui¹,

Kotecha²,

Gall³

et al. 2023

World J Gastrointest Surg

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“…Nevertheless, pancreatic resection surgery has been proven to be one of the best surgical procedures as it has been associated with less need for reoperation, so it should be considered over drainage [ 8 ]. When speaking about pancreatic resection, a distal pancreatectomy with splenectomy is one of the most commonly performed procedures for distal injuries, but proximal injuries require a stage-specific approach usually executed by an HPB surgeon [ 10 ]. In this particular case, it is important to mention that the primary surgeon involved in the case is an HPB specialist who decided that as part of this surgery, he was going to place closed suction drainage in the splenic bed as the probability of presenting a POPF was high due to the extension and magnitude of the pancreatic injury.…”

Section: Discussionmentioning

confidence: 99%

Complete Traumatic Rupture of the Pancreas by a Horse Saddle: A Case Report

Avila-Sanchez,

Pliego-Zermeño,

Barron-Cervantes

et al. 2024

Cureus

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Pancreatic trauma is one of the least observed diagnoses in the emergency room, much less in pediatric emergencies. Any cause of direct abdominal blunt trauma can cause it. With only a few cases presented in the literature, horse accidents have been associated with this complication, but it has been never seen in literature as a case where the horse-riding saddle is the one causing the pancreatic trauma, until now. Emphasizing the importance of an early diagnosis is the key point, but more importantly, to highlight that the correct diagnostic approach will grant the opportunity for a lesion in the main pancreatic duct to be identified, which will allow a timely surgical approach, increasing overall survival rates and decreasing morbidity in these patients. Here lies the importance of not only utilizing a specific study, such as a computerized tomography (CT) scan to evaluate abdominal trauma but also using other image studies that are better suited for pediatric patients, such as magnetic resonance image (MRI) with cholangiopancreatography (MRCP).

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“…When surgical management is needed, the options should be resection or a more limited approach. A distal pancreatectomy with splenectomy can be performed safely, but proximal injuries require a stage-specific approach[ 17 ].…”

Section: Indications and Options For Surgical Managementmentioning

confidence: 99%

Indications for the surgical management of pancreatic trauma: An update

Pavlidis¹,

Psarras²,

Symeonidis³

et al. 2022

WJGS

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Pancreatic trauma is rare compared to other abdominal solid organ injuries, accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade III to grade V injuries.

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Surgical management of pancreatic trauma in Australia

Abstract: Formal resection is not inferior to conservative surgical treatment in pancreatic trauma.

Cited by 8 publications

References 26 publications

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

Complete Traumatic Rupture of the Pancreas by a Horse Saddle: A Case Report

Indications for the surgical management of pancreatic trauma: An update

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