The nuanced nature of grading pancreas injuries: Response to letter to the editor

Ball, Chad G.; Biffl, Walter L.; Moore, Ernest E.

doi:10.1097/ta.0000000000003690

Cited by 1 publication

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“…Current reports indicated the use of intraoperative ultrasound to successfully locate the MPD. [16,17] If intraoperative ultrasound can consistently assist in locating the MPD, it may become a standard procedure for treating pancreatic injuries combined with complete disruption of the MPD using this hybrid surgery.…”

Section: Discussionmentioning

confidence: 99%

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Xu,

2024

Medicine

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Introduction: A complete disruption of main pancreatic duct (MPD) presents a significant challenge to the surgeon. Historically, the standard surgical approach for addressing a complete disruption of the MPD involved distal pancreatic resection and pancreaticojejunostomy Roux-en-Y anastomosis. Nevertheless, there have been no reported cases of hybrid surgery being employed for the complete disruption of the MPD. Patient concerns: A 63-year-old male patient presented with blunt trauma in the upper abdomen and was transferred to our trauma center 10 hours after injury. Upon arrival at the emergency department, he was conscious, hemodynamically stable, and complained of upper abdominal pain and distention. Physical examination revealed right upper abdominal tenderness and slight abdominal tension. Abdominal contrast-enhanced CT scan revealed a complete transection of pancreatic parenchyma at the junction of the head and neck. Diagnoses: Complete transection of pancreatic parenchyma at the junction of the head and neck combined with complete disruption of the MPD, AIS grade IV. Interventions: The hybrid surgery was initially utilized for complete MPD disruption, incorporating endoscope-assisted stent placement in the MPD along with primary repair of the pancreatic parenchyma and duct. Outcomes: The postoperative period went smoothly, and the patient recovered and was discharged 4 weeks after operation. The MPD stent was removed under endoscope 4 months after operation, and Endoscopic Retrograde Pancreatography examination showed that the MPD was patency and slight MPD stenosis without pancreatic leakage. At the most recent follow-up, the patient had returned to normal life and work without any pancreatic endocrine or exocrine dysfunction. Lessons: The hybrid surgery, incorporating endoscope-assisted MPD stent placement and primary repair of the pancreatic parenchyma and duct, emerges as a promising alternative for complete MPD disruption in hemodynamically stable patients. The challenge in this hybrid surgery is the precise localization of the distal end of the MPD.

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Section: Discussionmentioning

confidence: 99%

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Xu,

2024

Medicine

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The nuanced nature of grading pancreas injuries: Response to letter to the editor

Abstract: This response to the Letter to the Editor outlines the rationale and science behind the proposed AAST pancreas grading lexicon changes.

Cited by 1 publication

References 3 publications

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

Emergency hybrid surgery for transection of pancreas at the head and neck after blunt abdominal trauma: A case report and review of the literature

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