Clinical course and pancreas parenchyma sparing surgical treatment of severe pancreatic trauma
| Autor: | Brigitta Globke, Dietrich A. Ruess, Stefan Fichtner-Feigl, Ulrich T. Hopt, Uwe A. Wittel, Joachim Schoenberger, Sophia Chikhladze, Johann Pratschke, Marcus Bahra |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Abdominal Injuries Wounds Nonpenetrating Young Adult 03 medical and health sciences Pancreatectomy 0302 clinical medicine Blunt Germany medicine Humans Pancreas Retrospective Studies General Environmental Science Pancreatic duct 030222 orthopedics business.industry 030208 emergency & critical care medicine medicine.disease Surgery Treatment Outcome medicine.anatomical_structure Abdominal trauma Radiological weapon Concomitant General Earth and Planetary Sciences business Duct (anatomy) Penetrating trauma |
| Zdroj: | Injury. 51:1979-1986 |
| ISSN: | 0020-1383 |
| DOI: | 10.1016/j.injury.2020.03.045 |
| Popis: | Introduction Pancreatic trauma (PT) involving the main pancreatic duct is rare, but represents a challenging clinical problem with relevant morbidity and mortality. It is generally classified according to the American Association for the Surgery of Trauma (AAST) and often presents as concomitant injury in blunt or penetrating abdominal trauma. Diagnosis may be delayed because of a lack of clinical or radiological manifestation. Treatment options for main pancreatic duct injuries comprise highly complex surgical procedures. Patients and Methods We retrospectively analyzed clinical data from 12 patients who underwent surgery in two tertiary centers in Germany during 2003–2016 for grade III-V PT with affection of the main pancreatic duct, according to the AAST classification. Results The median age was 23 (range: 7-44) years. In nine patients blunt abdominal trauma was the reason for PT, whereas penetrating trauma only occurred in three patients. MRI outperformed classical trauma CT imaging with regard to detection of duct involvement. Complex procedures as i.e. an emergency pancreatic head resection, distal pancreatectomy or parenchyma sparing pancreatogastrostomy were performed. Compared to elective pancreatic surgery the complication rate in the emergency setting was higher. Yet, parenchyma-sparing procedures demonstrated safety. Conclusions Often extension of diagnostics including MRI and/or ERP at an early stage is necessary to guide clinical decision-making. If, due to main duct injuries, surgical therapy for PT is required, we suggest consideration of an organ preservative pancreatogastrostomy in grade III/IV trauma of the pancreatic body or tail. |
| Databáze: | OpenAIRE |
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