Traumatic Transection of Pancreas at the Neck: Feasibility of Parenchymal Preserving Strategy

Abstract

BackgroundTo assess the feasibility and safety of a pancreas preserving operative technique in the management of isolated complete pancreatic neck transection following blunt abdominal trauma.MethodsTwo patients with isolated blunt fracture of the pancreatic neck underwent pancreas preserving procedure comprising of oversewing of the proximal pancreas and Roux-en-Y pancreatico jejunostomy to the distal remnant. A feeding jejunostomy tube was placed for postoperative nutritional support in these patients. Both patients received subcutaneous octreotide 300 µg/day.ResultsTheir ages ranged from 15 years to 20 years, mode of injury was bicycle handle-bar injury (n = 2). Both had pancreatic transection at neck in the line of superior mesenteric vessels. One had ascites. These patients had pancreas parenchyma preserving surgery – internal drainage of the left remnant in a Roux-en-Y jejunal loop. The postoperative course was uneventful in these and both are well on follow-up.ConclusionsPancreas preserving strategy – suture of head side of pancreas and an internal drainage of left remnant with a Roux-en-Y jejunal loop is feasible and safe and should be considered in selected cases. Substantial amount of normal pancreatic parenchyma is preserved.

Primary Repair of Traumatic Complete Pancreatic Rupture

“…Patients with isolated blunt pancreatic injury, like our patient, have lower mortality which has been linked to early surgery and parenchyma-preserving procedures. 17 Moreover, in most of the cases retrieved from the literature search, the postoperative complications were self-limited. Even though the possibility of publication bias should be taken into consideration, these results merit further investigation.…”

Pancreaticojejunostomy in proximal pancreatic transection: A viable option

“…Nevertheless, the role of pancreatic duct stenting and repair in emergent situations is still unclear[ 8 ]. Of late, parenchyma preserving surgery has gained momentum, possibly as an attempt to retain the viscera and avoid the complications that arise from their absence[ 9 10 ]. Pancreaticojejunostomy and pancreaticogastrostomy are two possible options.…”

“…Although there are reports of increased complication rates after pancreaticoenterostomy, some of the recent studies have been contradictory. The incidence of pancreatic fistula formation has been more or less the same after distal pancreatectomy and pancreticoenterostomy: 30-50% and 6-50%, respectively[ 10 ]. However, the possibility of pancreatic insufficiency and the risk of post-splenectomy infections remain a significant concern after distal pancreatectomy and splenectomy[ 4 ].…”