Pancreas trauma: Six cases analysis

Abstract text (incl. references and figure legends)

Case history: Six male patients with a mean age of 30 years. Three were hospitalized for blunt trauma and three for penetrating trauma. Clinical findings: In addition to the trauma biomechanics and a complete physical examination, imaging tests were performed. Investigation/results: Three blunt trauma patients underwent FAST which showed free fluid, one patient with a gunshot wound underwent e-FAST which showed right hemopneumothorax and free fluid in the abdomen. A patient with a gunshot wound was previously submitted to a chest and abdomen CT scan. A patient with a penetrating foreign body injury was directly referred for exploratory laparotomy. Diagnosis: six patients with pancreatic trauma. Therapy and Progressions: Among patients with blunt trauma, one was submitted to a caudal pancreatectomy and splenectomy, one to a simple suture of the pancreas and one required left nephrectomy and caudal body pancreatectomy. Among patients with penetrating trauma, one was submitted to a caudal body pancretectomy, colonrhaphy, enterorrhaphy, gastrorraphy and right chest drainage, another was submitted to pancreas suture, duodenorrhaphy and colonrhaphy, and another patient with grade 2 pancreas injury was sutured and drainage. All patients received drains next to the pancreas. Three required blood transfusions. The mean hospital stay was 9 days. Three patients received only prophylactic antibiotics and three received antibiotic therapy for 7 days. Three patients received parenteral nutrition initially and then progressed to an oral diet. Two patients developed low output pancreatic fistula with satisfactory evolution. No deaths occurred. Comments: The management of pancreatic injuries is one of the most challenging situations for the surgeon. The correct identification of pancreatic lesions, associated with the appropriate therapeutic choice, are fundamental factors for the success of the treatment and better prognosis. References: Schmiegelow AF, Stockholm JH, Burgdorf SK. [Traumatic pancreatic lesions]. Ugeskr Laeger. 2019 Apr 15;181(16):V06180442. Danish. PMID: 31036150.

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