Vanessa Phillis Ho1, Nimitt J Patel, Faran Bokhari, Firas G Madbak, Jana E Hambley, James R Yon, Bryce R H Robinson, Kimberly Nagy, Scott B Armen, Samuel Kingsley, Sameer Gupta, Frederic L Starr, Henry R Moore, Uretz J Oliphant, Elliott R Haut, John J Como. 1. From the Division of Trauma, Department of Surgery (V.P.H., J.E.H.), Surgical Critical Care and Acute Care Surgery, University Hospitals Cleveland Medical Center; Division of Trauma, Department of Surgery (N.J.P., J.J.C.), Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio; Department of Trauma and Burn (F.B., K.N., S.G., F.L.S.), John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois; Department of Surgery (F.G.M.), University of Florida College of Medicine, Jacksonville, Florida; Department of Surgery (J.R.Y.), Swedish Medical Center, Englewood, Colorado; Division of Trauma and Burns, Department of Surgery (B.R.H.R.), Harborview Medical Center, University of Washington, Seattle, Washington; Division of Trauma, Department of Surgery (S.B.A.), Acute Care, & Critical Care Surgery, Penn State Hershey College of Medicine, Hershey, Pennsylvania; Department of Surgery (S.K.), Illinois Masonic Hospital, Chicago; Department of Surgery (H.R.M., U.J.O.), University of Illinois College of Medicine, Urbana, Illinois; and Division of Acute Care Surgery, Department of Surgery (E.R.H.), the Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
BACKGROUND: Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. METHODS: The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. RESULTS: Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. CONCLUSION: Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy. LEVEL OF EVIDENCE: Systematic review, level III.
BACKGROUND:Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. METHODS: The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation framework was used to formulate evidence-based recommendations. RESULTS: Three hundred nineteen articles were identified. Of these, 52 articles underwent full text review, and 37 were selected for guideline construction. CONCLUSION:Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or nonresectional management. For grade III/IV injuries identified on computed tomography or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for postoperative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of grade V injuries, and the need for routine splenectomy with distal pancreatectomy. LEVEL OF EVIDENCE: Systematic review, level III.
Authors: Noah S Rozich; Katherine T Morris; Tabitha Garwe; Zoona Sarwar; Alessandra Landmann; Chesney B Siems; Alexandra Jones; Casey S Butler; Paul K McGaha; Benjamin C Axtman; Barish H Edil; Jason S Lees Journal: J Trauma Acute Care Surg Date: 2019-12 Impact factor: 3.697