Outcomes of fifty-six surgical managed cases of blunt pancreatic injury

Abstract text (incl. references and figure legends)

Introduction: As pancreatic injuries (PIs) are relatively rare among blunt abdominal traumas, their management protocols are not yet established. The absence of the protocol may be responsible for delay in diagnosis and treatment of main pancreatic duct (MPD) injury, and for related increase in mortality rate. The purpose of this study is to investigate the association between background, diagnosis, surgical treatment, and outcome in PI cases, and to clarify their optimal management.

Material & Methods: We reviewed the records of 56 patients with blunt PI who underwent surgery in Saitama Medical Center from 2007 to 2021. We examined backgrounds of the cases, grades and regions of the injury, hemodynamical status on admission, injury severity scores (ISS), operative procedures, and evaluated their associations with outcomes or post-operative complications.

Results: The cases were 48 males and 10 females with the median age of 42 years (range: 4 to 81 years) and the median ISS of 26 (9 to 54). PIs involved 14 pancreas heads, 14 bodies, 28 tails and 22 main pancreatic ducts. Surgical procedures included 3 pancreatico-duo- denectomys, one middle segmental resection, 21 distal resections, 17 simple sutures, and 14 peritoneal drainages without pancreatic maneuver. We performed duodenotomy and MPD catheterization in 14 cases with no appreciable complications. Incidence of pancreatic fistula or pseudocyst were relatively high in cases with pancreatic head injury (50.0%), MPD injury (50.0%), and those underwent distal resection (52.4%).

Conclusion: The intra-operative pancreatography and MPD decom- pression is safe and useful technique for the diagnosis and treatment of MPD injury, especially when severely injured pancreas head is preserved. Incidence of pancreatic fistula and pseudocyst should be taken into consideration, when deciding the indication and method of surgical management for PI.

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