Being-Chuan Lin1, Yon-Cheong Wong2, Ray-Jade Chen3, Nai-Jen Liu4, Cheng-Hsien Wu2, Tsann-Long Hwang5, Yu-Pao Hsu6. 1. Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan, ROC. linbc@cgmh.org.tw. 2. Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC. 3. Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC. 4. Department of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC. 5. Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC. 6. Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan, ROC.
Abstract
BACKGROUND: To evaluate the management and outcomes of blunt pancreatic injuries based on the integrity of the major pancreatic duct (MPD). METHODS: Between August 1996 and August 2015, 35 patients with blunt pancreatic injuries underwent endoscopic retrograde pancreatography (ERP). Medical charts were retrospectively reviewed for demography, ERP timing, imaging findings, management, and outcome. RESULTS: Of the 35 patients, 21 were men and 14 were women, with ages ranging from 11 to 70 years. On the basis of the ERP findings, we propose a MPD injury classification as follows: class 1 indicates normal MPD; class 2, partial injury with intact MPD continuity; and class 3, complete injury with disrupted MPD continuity. Both classes 2 and 3 are subdivided into classes a, b, and c, which represent the pancreatic tail, body, and head, respectively. In this report, 14 cases belonged to class 1, 10 belonged to class 2, and 11 belonged to class 3. Of the 14 patients with class 1 injuries, 10 underwent nonsurgical treatment and 4 underwent pancreatic duct stenting. Of the 10 patients with class 2 injuries, 4 underwent nonsurgical treatment and 6 underwent pancreatic duct stenting. Two of the 11 patients with class 3 injuries underwent pancreatic duct stenting; one in the acute stage developed sepsis that led to death even after converting to distal pancreatectomy plus splenectomy. Of the 11 patients with class 3 injuries, spleen-preserving distal pancreatectomy was performed in 6, distal pancreatectomy plus splenectomy in 2, and Roux-en-Y pancreaticojejunostomy after central pancreatectomy in 2. The overall pancreatic-related morbidity rate was 60% and the mortality rate was 2.8%. CONCLUSION: Based on our experience, class 1 and 2 injuries could be treated by nonsurgical means and pancreatic duct stenting could be an adjunctive therapy in class 2b and 2c injuries. Operation is warranted in class 3 injuries.
BACKGROUND: To evaluate the management and outcomes of blunt pancreatic injuries based on the integrity of the major pancreatic duct (MPD). METHODS: Between August 1996 and August 2015, 35 patients with blunt pancreatic injuries underwent endoscopic retrograde pancreatography (ERP). Medical charts were retrospectively reviewed for demography, ERP timing, imaging findings, management, and outcome. RESULTS: Of the 35 patients, 21 were men and 14 were women, with ages ranging from 11 to 70 years. On the basis of the ERP findings, we propose a MPD injury classification as follows: class 1 indicates normal MPD; class 2, partial injury with intact MPD continuity; and class 3, complete injury with disrupted MPD continuity. Both classes 2 and 3 are subdivided into classes a, b, and c, which represent the pancreatic tail, body, and head, respectively. In this report, 14 cases belonged to class 1, 10 belonged to class 2, and 11 belonged to class 3. Of the 14 patients with class 1 injuries, 10 underwent nonsurgical treatment and 4 underwent pancreatic duct stenting. Of the 10 patients with class 2 injuries, 4 underwent nonsurgical treatment and 6 underwent pancreatic duct stenting. Two of the 11 patients with class 3 injuries underwent pancreatic duct stenting; one in the acute stage developed sepsis that led to death even after converting to distal pancreatectomy plus splenectomy. Of the 11 patients with class 3 injuries, spleen-preserving distal pancreatectomy was performed in 6, distal pancreatectomy plus splenectomy in 2, and Roux-en-Y pancreaticojejunostomy after central pancreatectomy in 2. The overall pancreatic-related morbidity rate was 60% and the mortality rate was 2.8%. CONCLUSION: Based on our experience, class 1 and 2 injuries could be treated by nonsurgical means and pancreatic duct stenting could be an adjunctive therapy in class 2b and 2c injuries. Operation is warranted in class 3 injuries.
Authors: E E Moore; T H Cogbill; M A Malangoni; G J Jurkovich; H R Champion; T A Gennarelli; J W McAninch; H L Pachter; S R Shackford; P G Trafton Journal: J Trauma Date: 1990-11
Authors: Federico Coccolini; Leslie Kobayashi; Yoram Kluger; Ernest E Moore; Luca Ansaloni; Walt Biffl; Ari Leppaniemi; Goran Augustin; Viktor Reva; Imitiaz Wani; Andrew Kirkpatrick; Fikri Abu-Zidan; Enrico Cicuttin; Gustavo Pereira Fraga; Carlos Ordonez; Emmanuil Pikoulis; Maria Grazia Sibilla; Ron Maier; Yosuke Matsumura; Peter T Masiakos; Vladimir Khokha; Alain Chichom Mefire; Rao Ivatury; Francesco Favi; Vassil Manchev; Massimo Sartelli; Fernando Machado; Junichi Matsumoto; Massimo Chiarugi; Catherine Arvieux; Fausto Catena; Raul Coimbra Journal: World J Emerg Surg Date: 2019-12-11 Impact factor: 5.469