Management of pancreatic trauma in a tertiary care referral centre

Abstract text (incl. references and figure legends)
Introduction

Pancreatic trauma (PT) is an uncommon event often difficult to diagnose at an early stage. Pancreatic trauma occurs in approximately 4% abdominal trauma. The pancreas has an intimate relationship with the major upper abdominal vessels, and there is significant morbidity and mortality associated with severe pancreatic injury.

Material & Methods

A retrospective study conducted between 2009 and 2021 in a tertiary care referral centre with 12 consecutive patients who presented to the emergency department with a history of abdominal trauma were registered. The CT findings and AAST grade of pancreatic injury, various intra-abdominal injuries and time elapsed since injury and other associated factors were analyzed.

Results

The median age was 28.5 (range: 20-44) years. In nine patients blunt abdominal trauma was the reason for PT, whereas penetrating trauma only occurred in three patients. Injury severity score was 11,16 (9-21). Of a total of 12 PT, 8 were grades II or I, 2 were grade III and 1 was grade IV. Procedures as i.e. an distal pancreatectomy or simple drainage were performed. Yet, parenchyma-sparing procedures demonstrated safety.

Conclusions

The diagnosis of pancreatic trauma requires a high index of suspicion and detailed imaging studies. Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption, and in these cases, experienced surgeons should be involved. Complications following pancreatic trauma are common and the majority can be managed without further surgery.

References - Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: a prospective study with systematic review. Injury. 2014 Sep;45(9):1384-93. - Clinical course and pancreas parenchyma sparing surgical treatment of severe pancreatic trauma. Injury.2020;51(9):1979-1986.

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