Morgan Schellenberg1, Kenji Inaba2, James M Bardes3, Vincent Cheng4, Kazuhide Matsushima5, Lydia Lam6, Elizabeth Benjamin7, Demetrios Demetriades8. 1. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: morgan.schellenberg@med.usc.edu. 2. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: kinaba@surgery.usc.edu. 3. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: james.bardes@med.usc.edu. 4. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: chengvin@usc.edu. 5. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: kazuhide.matsushima@med.usc.edu. 6. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: lydia.lam@med.usc.edu. 7. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: elizabeth.benjamin@med.usc.edu. 8. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, 2051 Marengo Street, IPT C5L100, Los Angeles, CA 90033, United States. Electronic address: demetrios.demetriades@med.usc.edu.
Abstract
BACKGROUND: Pancreatic trauma management hinges upon the presence or absence of pancreatic duct injury, but the optimal method of assessment is unclear. This study endeavored to evaluate the methods of pancreatic duct assessment in modern practice. METHODS: Patients presenting to LAC + USC Medical Center (01/2008-06/2015) with a pancreatic injury were identified (ICD-9 codes). Demographics, clinical data, technique of duct evaluation, and outcomes were analyzed. RESULTS: 71 patients with pancreatic injury were identified. 21 patients (30%) underwent CT scan (sensitivity 76%). Sixteen (76%) then underwent laparotomy while 5 (24%) were managed successfully nonoperatively. Most (n = 50, 70%) underwent immediate laparotomy. Overall, 66 patients (93%) were managed operatively. The majority were assessed intraoperatively for ductal injury with visual inspection alone (n = 62, 94%). Four (6%) underwent intraoperative pancreatography via duodenotomy/cholecystotomy, which were all inconclusive. CONCLUSION: In the evaluation of pancreatic duct injury, intraoperative pancreatography is frequently inconclusive and should have a limited role. Clinical suspicion for ductal injury based on intraoperative visual inspection alone should guide the management of pancreatic injuries.
BACKGROUND:Pancreatic trauma management hinges upon the presence or absence of pancreatic duct injury, but the optimal method of assessment is unclear. This study endeavored to evaluate the methods of pancreatic duct assessment in modern practice. METHODS:Patients presenting to LAC + USC Medical Center (01/2008-06/2015) with a pancreatic injury were identified (ICD-9 codes). Demographics, clinical data, technique of duct evaluation, and outcomes were analyzed. RESULTS: 71 patients with pancreatic injury were identified. 21 patients (30%) underwent CT scan (sensitivity 76%). Sixteen (76%) then underwent laparotomy while 5 (24%) were managed successfully nonoperatively. Most (n = 50, 70%) underwent immediate laparotomy. Overall, 66 patients (93%) were managed operatively. The majority were assessed intraoperatively for ductal injury with visual inspection alone (n = 62, 94%). Four (6%) underwent intraoperative pancreatography via duodenotomy/cholecystotomy, which were all inconclusive. CONCLUSION: In the evaluation of pancreatic duct injury, intraoperative pancreatography is frequently inconclusive and should have a limited role. Clinical suspicion for ductal injury based on intraoperative visual inspection alone should guide the management of pancreatic injuries.
Authors: Carlos A Ordoñez; Michael W Parra; Mauricio Millán; Yaset Caicedo; Natalia Padilla; Mónica Guzmán-Rodríguez; Fernando Miñan-Arana; Alberto García; Adolfo González-Hadad; Luis Fernando Pino; Fernando Rodríguez-Holguin; José Julián Serna; Alexander Salcedo; Ricardo Ferrada; Rao Ivatury Journal: Colomb Med (Cali) Date: 2020-12-30
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