Pancreatic injury

Management

Diagnosis

The diagnosis of this form of injury can be challenging because of the pancreas' location inside the abdomen. The use of ultrasound can reveal fluid around the site of injury. Computed tomography (CT) can also be utilized as a non-invasive diagnostic tool, but its reliability is low; one retrospective case review found that computed tomography had either failed to find injuries or had underestimated the severity of injury in more than half of 17 pancreatic injury patients.

Management of a pancreatic injury can be difficult because other abdominal organs, such as the liver, usually have sustained trauma as well. Several common symptoms manifest hours after the injury such as tachycardia, abdominal distension, and mid-epigastric tenderness. Indications for surgical intervention include: peritonitis based on physical examination; hypotension in combination with a positive focussed assessment with sonography (ultrasound) for trauma (FAST); and pancreatic duct disruption based on the results of thin-cut computed tomography or endoscopic retrograde cholangiopancreatography (ERCP). Commonly, a laparotomy is done in order to directly visualize the injury, and generally this approach is the most accurate diagnostic method.

Classification

Pancreatic injuries are classified according to the criteria of the American Association for the Surgery of Trauma (AAST). The grade of the trauma should be increased by one level for multiple injuries to the same organ. The description of the injury is that "based on most accurate assessment at autopsy, laparotomy, or radiological study." The pancreatic organ injury scale, as minimally modified, is:

Surgical treatment

When there is no pancreatic duct injury, typically hemostasis and surgical drainage are the main form of treatment. Common complications after surgery include pancreatitis, pancreatic fistula, abscess, and pseudocyst formation. Initial management of hemorrhage includes controlling it by packing the wound.

History

The first recorded case of pancreatic injury was published in The Lancet in 1827. At the time, death as a result of injury was deemed to be "universal". The first successful surgery to repair a transected pancreas was performed in 1904 by Garré, who reported the case the following year.

References

External links

References

1. (January 2008). "Management of pancreatic trauma". Injury.
2. (2003). "Pancreatic trauma". Trauma.
3. (2007). "Pancreatic Trauma Revisited*". European Journal of Trauma and Emergency Surgery.
4. (2001). "Surgical Treatment: Evidence-Based and Problem-Oriented". Zuckschwerdt.
5. (December 2010). "The management of pancreatic trauma". Journal of the Royal Army Medical Corps.
6. (2002). "History of the pancreas: mysteries of a hidden organ". Kluwer Academic.
7. (September 1905). "Abstracts of Current Literature". Franklin H. Martin Memorial Foundation, American College of Surgeons.
8. (2010). "Surgical Management of Hepatobiliary and Pancreatic Disorders".