PURPOSE: To study the mechanism, management and outcome of patients who had sustained pancreatic trauma. METHODOLOGY: Patients who were treated for pancreatic trauma in Al-Ain Hospital between October 2002 and August 2007 were retrospectively studied. RESULTS: All eleven patients were males having a median age of 30 years (range 24-52 years). Nine had blunt trauma while two had suffered penetrating injury. Three presented with shock. associated injuries were present in nine patients (head, chest, and extremities) while seven had other intra-abdominal injuries. Only one patient had isolated pancreatic injury. Early serum amylase was elevated in six patients. CT abdomen was diagnostic for pancreatic injury in seven patients. Two cases were missed by early CT scan (sensitivity of 78%) while the remaining two patients were taken immediately to the operating theater. All patients underwent laparotomy. Five patients were treated by drainage alone, four had distal pancreatectomy, abdominal packing was performed in one patient and in another gastrocystostomy was carried out. Pancreatic fistula occurred in three patients. Median hospital stay was 25 days (range 12-152 days). Two patients (18%) died. CONCLUSIONS: Blunt trauma is the main cause of pancreatic injury in our country. Early CT scan may miss pancreatic injury in almost a quarter of the patients. Thin sliced CT scan, with special views in a dedicated abdominal pancreatic study, is recommended. A high index of clinical suspicion, depending on the mechanism of injury, is important for diagnosis of pancreatic injury. Mortality is mainly attributable to other associated injuries so simple procedures should initially be adopted for pancreatic injury, especially in haemodynamically unstable patients.
PURPOSE: To study the mechanism, management and outcome of patients who had sustained pancreatic trauma. METHODOLOGY:Patients who were treated for pancreatic trauma in Al-Ain Hospital between October 2002 and August 2007 were retrospectively studied. RESULTS: All eleven patients were males having a median age of 30 years (range 24-52 years). Nine had blunt trauma while two had suffered penetrating injury. Three presented with shock. associated injuries were present in nine patients (head, chest, and extremities) while seven had other intra-abdominal injuries. Only one patient had isolated pancreatic injury. Early serum amylase was elevated in six patients. CT abdomen was diagnostic for pancreatic injury in seven patients. Two cases were missed by early CT scan (sensitivity of 78%) while the remaining two patients were taken immediately to the operating theater. All patients underwent laparotomy. Five patients were treated by drainage alone, four had distal pancreatectomy, abdominal packing was performed in one patient and in another gastrocystostomy was carried out. Pancreatic fistula occurred in three patients. Median hospital stay was 25 days (range 12-152 days). Two patients (18%) died. CONCLUSIONS:Blunt trauma is the main cause of pancreatic injury in our country. Early CT scan may miss pancreatic injury in almost a quarter of the patients. Thin sliced CT scan, with special views in a dedicated abdominal pancreatic study, is recommended. A high index of clinical suspicion, depending on the mechanism of injury, is important for diagnosis of pancreatic injury. Mortality is mainly attributable to other associated injuries so simple procedures should initially be adopted for pancreatic injury, especially in haemodynamically unstable patients.
Authors: Sami Shaban; Mazen Ashour; Masoud Bashir; Yousef El-Ashaal; Frank Branicki; Fikri M Abu-Zidan Journal: World J Emerg Surg Date: 2009-11-24 Impact factor: 5.469