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23rd European Congress of Trauma & Emergency Surgery

Ass. Prof.

The role of CT scan in the management of post operative penetrating abdominal and thoracic trauma: A balancing act between diagnostic accuracy and environmental impact

Emergency surgery

Trauma and Emergency surgery | Miscellaneous

Introduction Post-operative CT imaging of the chest, abdomen and pelvis for penetrating injuries is performed at variable rates post-trauma thoracotomy or laparotomy and show low rates of occult injury detection (1,2). Additional imaging may delay resuscitation, add radiation exposure and increase costs to healthcare systems. We aim to investigate the utility of CT imaging within 24 hours of surgery in patients with penetrating injuries. Methods We performed a retrospective review of penetrating trauma laparotomy and thoracotomy patients at a Major Trauma Centre between December 2016 and December 2022. Patients were included if they had no preoperative CT imaging. Data was collected including the mechanism of injury, surgery performed, imaging performed and findings. Results A total of 261 trauma laparotomy cases and 58 trauma thoracotomy cases were reviewed. Forty patients had no CT pre-laparotomy and 55% (n = 33) underwent a CT abdomen/pelvis within 24 hours of surgery. No CT scans found injuries that changed clinical management and 9% (n = 2) had injuries that were conservatively managed. Twenty-two patients had no CT pre-thoracotomy and 50% of these patients (n = 11) would go on to have a CT chest within 24 hours of thoracotomy. None of these CT scans showed occult injuries. Conclusions CT imaging done within 24 hours of laparotomy or thoracotomy in penetrating injuries did not change clinical management. Avoiding such imaging could be beneficial to the patients, the environment and budgets of healthcare systems. References Mendoza AE, Wybourn CA, Charles AG, Campbell AR, Cairns BA, Knudson MM. Routine computed tomography after recent operative exploration for penetrating trauma: What injuries do we miss? J Trauma Acute Care Surg. 2017 Oct;83(4):575-578. doi: 10.1097/TA.0000000000001558. Weis, J. J. , Cunningham, K. E. , Forsythe, R. M. , Billiar, T. R. , Peitzman, A. B. &amp; Sperry, J. L. (2014). Surgery, 156 (4), 979-987. doi: 10.1016/j.surg.2014.06.044. No

Poster

Prof.

Beyond mediastinal widening: Innovative screening and prediction methods for aortic injury

Visceral trauma

Introduction: Traditional use of mediastinal widening as an indicator of aortic injury in trauma patients is being questioned due to its limited accuracy. Our study proposes a more reliable diagnostic method. Material &amp; Methods: We performed a retrospective analysis of patients who had chest CT scans and measured the mediastinum (&gt;8 cm indicating widening). Data collected included demographics and lab results. We used logistic regression to develop a diagnostic model, which we evaluated against mediastinal widening using ROC curves. Results:During the period from 2019 to 2022, a total of 592 patients received contrast-enhanced chest CT scans at our facility. Out of these patients, 51 experienced traumatic aortic injuries. In univariate logistic regression analysis, significant risk factors for traumatic aortic injury included:Gender (Male; OR: 1.99, 95% CI: 0.82-4.86), Mediastinal widening (OR: 3.25, 95% CI: 1.38-7.68), Hemothorax (OR: 2.89, 95% CI: 1.23-6.77), Femoral Fracture (OR: 4.44, 95% CI: 1.677-11.677), Elevated Troponin-I (&gt;0.3; OR: 4.125, 95% CI: 1.074-15.845), Elevated Lactate (&gt;19.8; OR: 2.477, 95% CI: 1.07-5.72). Utilizing these significant predictors, a model was established through multiple logistic regression analysis. The resulting Receiver Operating Characteristic (ROC) curve yielded an Area Under the Curve (AUC) of 0.845, demonstrating superior diagnostic accuracy when compared to the use of mediastinal widening alone, which had an AUC of 0.632 Conclusions: Our improved logistic regression model with an AUC of 0.845 outperforms mediastinal widening in diagnosing aortic injury and could enhance clinical outcomes, warranting further validation. Reference: 1. Shibahashi K, Matsunaga H, Ishida T, Sugiyama K, Hamabe Y. A new screening model for quantitative risk assessment of blunt thoracic aortic injury. European journal of trauma and emergency surgery : official publication of the European Trauma Society 2022; 48 (6):4607-4614.No

Exploring aortic morphology and determining variable-distance insertion lengths for fluoroscopy-free resuscitative endovascular balloon occlusion of the aorta (REBOA)

Research

Introduction REBOA is used for temporary control of non-compressible truncal hemorrhage (NCTH) as bridge to definitive surgery. The dependence on fluoroscopy for safe balloon positioning limits the extended use of REBOA in civilian &amp; military pre-hospital settings. This study was conducted to gain more insight in aortic morphology variation. We aimed to determine sex &amp; age-based variable-distance catheter insertion lengths for correct REBOA positioning without fluoroscopic confirmation. Methods Contrast enhanced CT-scans from civilian non-trauma patients were analyzed. Central luminal line distances were measured from both femoral artery access points (AAP) to the middle of aortic zones &amp; zone boundaries. Means to mid-zones and 95% confidence intervals for the boundary-distances were calculated. Potentially safe regions would be located between the upper &amp; lower confidence limits of the inferior &amp; superior boundary-distances, respectively. Regions were determined for all (combined) sex &amp; age-based subgroups. Results 1354 patients (660 males) were included. All distances were significantly longer in males and elderly. The right iliofemoral trajectory was 7 mm longer than the left. Zone III showed a remarkably consistent length of around 90 mm for all subgroups. Subgroup length variety is mainly seen in the iliofemoral trajectory &amp; the relatively short zone II, which increases 25% in length over time. High error rates up to 80% were seen when applying previously proposed distances for zone 3. Conclusion This study is the first to compare aortic morphology between combined sex &amp; age-based subgroups. We identified potentially safe regions for REBOA; necessary insertion lengths differed significantly between subgroups. Earlier published lengths by other groups would have resulted in high out-of-zone errors. Our proposed variable-distance insertion lengths can facilitate more accurate fluoroscopy-free REBOA positioning in austere, resource limited settings. No

eposter only

Severe liver injury in a 12-year-old child

Purpose:To present management of grade V liver injury in a 12-year-old child. Materials and methods:A 12-year-old boy admitted after falling from electric scooter and hitting on the handlebar by his stomach. He was in conscious, hemodynamically stable, pale, complaining on difficulty breathing. Results:FAST results were positive (large hemoperitoneum). During CT hemodynamic disturbances occurred. The child was urgently transferred to the operating room. Using damage-control tactic median laparotomy and packing of the abdominal cavity was performed. After revision, liver packing was performed. Total volume of blood loss was 3.5 liters, 1300 ml was collected by Cell-saver, and 600 ml of erythrocyte suspension was reinfused. The surgery was completed by abdominal VAC-system. Patient was transferred to ICU. After 36 hours the packs around the liver were removed, there was no evidence of continued bleeding, the abdomen was sutured. The postop period was complicated with multiple organ failure and sepsis. On POD14 formation of arteriovenous fistula of the liver was noted. Embolization of the right hepatic artery branches with microcoils was performed. After one month after surgery formation of biloma of the right lobe of the liver was diagnosed. Under ultrasound guidance, drainage was performed with a pigtail catheter. On the 38th day after trauma, the patient was transferred from ICU to surgical department, on 63rd day–he was discharged. Complete recovery of liver parenchyma was noted. Follow-up for 3 years - without complications. Conclusion:We present a clinical case of a 12-year-old patient with grade V liver injury to whom we successfully applied damage-control tactic. Arteriovenous fistula and biloma of the right lobe of the liver in the postoperative period were managed with minimally invasive techniques. Correct treatment and diagnostic tactics lead to improved treatment results and increase in survival rate of patients with severe trauma to the abdominal organs.No

Two surprises in the spleen

A 60-year-old woman presented at Emergency Department with chest and abdominal pain due to an accidental fall from own height. Past medical history was relevant for obesity, obstructive sleep apnoea and degenerative spinal pathology. She was hypotensive on arrival, but with a normal heart rate. His abdominal examination was significant for left upper quadrant tenderness with no signs of peritonitis. Abdominal CT scan revealed fractures of the 8th, 9th, 10th and 11th ribs on the left chest and, in the abdomen, the spleen showed heterogeneous enhancement, with extensive lacerations involving more than 50% of the splenic parenchyma, compatible with AAST grade IV traumatic injury. Evident hemoperitoneum in the paracolic recesses, Morrison's space, left perihepatic and pelvic excavation was present. An emergency surgery – a splenectomy - was performed. Patient"s clinical course was favorable. Unexpectedly, anatomopathological findings showed that the red pulp is dilated and predominantly congested and the white pulp is expanded, especially in the marginal zone, by a monocytoid population with expression of CD20 and Bcl-2, in the absence of expression of CD3, CD5, CD23, Cyclin D1, CD10 and Bcl-6. The morphological and immunohistochemical aspects are suggestive of splenic lymphoma of the marginal zone (SLMZ). SMZL represents a rare chronic B lymphocyte proliferative disease, which only represents about 0.9% of all non-Hodgkin"s lymphoma and it was considered a specific pathological entity only in 1991. About 25% of the patients are asymptomatic and the presence of B symptoms or high lactate dehydrogenase levels (LDH) at diagnosis is not usual. Patients may be accompanied by upper abdominal discomfort or splenomegaly. Although most of the cases of SMZL have an indolent course with median overall survival of about 10 years, nearly 30% of the patients develop aggressive disease, with median overall survival of only 4 years.No

Sigmoid colon injury following blunt abdominal trauma: A case report

Case history, clinical findings, Investigation/Results A 20-year-old man was brought to the emergency room after a motor vehicle accident. At the emergency room the patient was alert, conscious, oriented and hemodynamically stable. Abdominal tenderness and rigidity were present in the lower quadrants. A CT scan was performed which showed pneumoperitoneum present in practically all peritoneal recesses of the abdomen and in the pelvic cavity. A perforated hollow viscus was not categorically identified. The patient was taken to the operating room. Diagnosis, Therapy and Progressions An exploratory laparotomy was performed. During the procedure, a large amount of contaminated intraperitoneal fluid was aspirated. Massive fecal peritonitis and a 1.5 x 1 cm perforation over the anterior aspect of the proximal sigmoid colon was noted. Furthermore, there was a laceration of the sigmoid mesocolon measuring approximately 10 cm, leading to ischemia of this sigmoid segment. A sigmoid colectomy with end colostomy was performed. Restoration of bowel continuity was successfully performed after 8 months. Comments Isolated colon injuries following blunt abdominal trauma have been reported but the involvement of the sigmoid colon is a rare entity. The most common cause of traumatic colonic injuries is motor vehicle accidents. Proposed mechanisms for colon injuries post blunt abdominal trauma are bowel crushing against vertebrae, rapid pressure accentuating involvement of specific narrow segments of the colon, and colonic/ mesentery shearing. The choice of the surgical treatment depends on the intraoperative findings, like inflammation/contamination and perforated segment condition. References Isolated Sigmoid Colon Perforation in the Setting of Blunt Abdominal Trauma: A Case Series. Aviral S. et al - PubMed 2022 Nov 16 Delayed presentation of a sigmoid colon injury following blunt abdominal trauma: a case report. Gokhan E. et al - PubMed 2012 Aug 20No

Watch and wait in mesocolon hematoma – Is it feasible?

Mesenteric injuries occur in up to 5% of cases of blunt abdominal trauma. Mesocolon injuries are rare, with an estimated incidence of 0.1-0.5%. The diagnosis requires a high degree of clinical suspicion, since patients may present with late unspecific symptoms, going unnoticed on initial clinical assessment. We present a clinical case of a large mesenteric hematoma in a clinically stable patient, successfully managed with conservative treatment. Female, 23 years old, referred to the emergency department after a car accident. The patient was wearing a seatbelt and denied loss of consciousness or symptoms prior to the collision. After an initial period of observation, the patient began complaining of constant abdominal pain in the lower quadrants. On physical examination, the abdomen was tender, and a mass was palpable in the left lower quadrant, but there were no signs of peritoneal irritation. Blood samples revealed hemoglobin of 14.2mg/dL. Abdominal-pelvic CT scan showed a 6x8x5cm collection adjacent to the sigmoid colon, compatible with a mesocolon hematoma, with active bleeding albeit of low output. The patient was kept under monitorization and repeated analytical and imaging tests 6 hours later, with no further remarks. Conservative treatment was proposed, and she was transferred to the intensive care unit. Hemoglobin levels remained stable with clinical improvement. The patient was discharged on the 6th day and remains asymptomatic to date. In the absence of concomitant lesions and in hemodynamically stable patients, the approach to patients with mesocolon hematoma may include active surveillance and conservative treatment. In cases with evidence of intestinal ischemia, rupture of the mesentery or active bleeding a surgical intervention may be required. This clinical case highlights the importance of a tailored and multidisciplinary approach with detailed clinical and imaging evaluation in the context of blunt abdominal trauma.No

Contemporary management and outcomes of penetrating traumatic AAST-OIS grade III and IV kidney injuries: A TQIP analysis

Polytrauma

Introduction: Traditionally the management of AAST IOS Grade III and IV penetrating kidney injuries at time of laparotomy has been nephrectomy. Objective: The objective of the current study was to delineate the current management and outcomes using a large national database in this subset of trauma patients. Patients and Methods: The 2013-2021 TQIP dataset was queried for patients with Grade III and IV kidney injuries who had been subjected to laparotomy within 24h of admission. Patients were grouped based on the management strategy used for managing the kidney injury: Surgical (total or partial nephrectomy) vs. conservative (no nephrectomy). Grade 3 and 4 kidney injuries were analyzed separately for management and outcomes. Results: A total of 2214 Grade III and 2669 grade IV kidney injuries were included in the current investigation. The majority of grade III injuries were managed conservatively (89%, N = 1965) while only half of grade IV injuries were conservatively managed (54%, N = 1439). After adjusting for potential confounders, nephrectomy among patients with grade III penetrating kidney injuries was associated with an 86% increase in the risk of mortality [adjusted IRR (95% CI): 1.86 (1.32-2.62), p &lt;0.001] and a 39% increased risk of complications [adjusted IRR (95% CI): 1.39 (1.18-1.65), p &lt;0.001] compared to conservative management. There were no significant differences in the risk of complications or mortality in patients with Grade IV injuries based on the management strategy for the kidney injury. Conclusion: The contemporary data shows that majority of Grade III penetrating kidney injuries are managed without nephrectomy with good overall outcome. For Grade IV injuries half of patients underwent nephrectomy; however, no difference in morbidity or mortality could be detected between the groups.No

The significance of triphasic multidetector CT for blunt abdominal trauma patients

Introduction: Recognizing the American Association for the Surgery of Trauma (AAST) 2018 guidelines, we assess the efficacy of triphasic CT scans in blunt abdominal trauma cases to improve diagnostic precision and resource use. Material &amp; Methods: A retrospective study of blunt abdominal trauma patients was conducted, comparing angiographic confirmations with CT findings across biphasic and triphasic (non-contrast, arterial, and portal phases) scans. Results: In the period spanning 2019 to 2021, a total of 403 patients underwent contrast-enhanced trunk CT scans. Among these, 136 patients proceeded to angiography. Among those who underwent CT, 100 showed positive findings in biphasic CT, 25 displayed positive findings in the portal phase of triphasic CT, and 11 in the arterial phase of triphasic CT. Within the latter group, 11 patients exhibited additional arterial phase findings, including spleen vascular lesions (54.5%, comprising 5 pseudoaneurysms and 1 AV shunt) and liver vascular lesions (45.5%, consisting of 3 AP shunts and 1 pseudoaneurysm). In the subset with positive findings solely in the arterial phase, the original spleen AAST grades in biphasic CT ranged from grade II to IV, and liver AAST grades ranged from III to IV. Conclusions:Triphasic CT, particularly in the arterial phase, significantly improves the detection and grading of blunt abdominal trauma, aligning with AAST guidelines and enhancing patient care and efficient use of medical resources. References: 1. Kawinwongkowit K, Kaewlai R, Kasemassawachanont A, Chatpuwaphat J, Kumthong N, Somcharit L. Value of contrast-enhanced arterial phase imaging in addition to portovenous phase in CT evaluation of blunt abdominopelvic trauma. Eur Radiol 2023; 33 (3):1641-1652 No

Usability of an artificial intelligence clinical decision support system for trauma: A prospective study

Introduction Trauma-induced coagulopathy (TIC) affects 25% of severely injured patients, and mortality approaches 50%. An Artificial Intelligence (AI) model to predict the risk of TIC was developed, validated, and integrated into a clinical decision support system (CDSS). This study aimed to evaluate the usability, usefulness and trustworthiness of our AI CDSS. Material &amp; Methods This prospective study was approved by the UK Health Research Authority (22/HRA/2324). Participants tested the CDSS by inputting simulated data into its interface and interpreting its risk prediction output (Fig 1). Usability issues were captured using "think aloud" methodology, categorised using Nielsen&quot;s Heuristics (NH), and graded for severity (1=cosmetic, 2=minor, 3=major, 4=catastrophic). A validated questionnaire was administered based on the System Usability Scale (SUS) and Technology Acceptance Model. Results Participants (n=22) had a median age of 39 years (IQR 31-48), 73% were male, 77% were doctors, 18% nurses and 5% paramedics, with a median of 13.5 years (IQR 6.3-19.8) experience. Usability issues were identified in 10/10 NH categories (Fig 2): 68 input-, 1 output-v, and 6 explanation-related (average severity 2.0/4, 1.0/4, and 1.8/4, respectively). The most common issues were consistency and standards (n=25), flexibility and efficiency (n=11), and user control and freedom (n=10). The CDSS achieved a SUS score of 79 (standard is ≥68). Participants said it would be clinically useful (77% agreed), improve performance (50%), and enhance effectiveness (55%). An explanation embedded within the CDSS increased transparency (96%), and decision confidence (82%). Conclusions This prospective study demonstrated acceptable usability, usefulness and trustworthiness of an AI CDSS, though user interface issues persist. Iterative system improvements will be necessary prior to a randomised controlled trial. Fig 1. CDSS input and output Fig 2. NH usability issues Disclosures: JMW, RSS, EP, EK, WM, ZP, and NT have received research funding from the United States Department of Defense. RSS is also funded by the Royal College of Surgeons of Edinburgh and Orthopaedic Research UK. JMW has received funding from the Royal College of Surgeons of England and Rosetrees Trust. For the remaining authors, none were declared.

Penetrating trauma to the neck and abdomen – A suicide attempt

CASE HISTORY: A 49-year-old male, with a history of cirrhosis and alcoholism, was admitted to the ER with stab wounds to the neck and abdomen after an attempted suicide. CLINICAL FINDINGS: On arrival, he was lethargic, had no dysphonia and complained of abdominal pain. His vitals were BP 75/56mmHg and HR 56bpm. The physical examination revealed a zone 2 penetrating neck injury (PNI) with exposure of the trachea and two periumbilical lacerations, with peritoneal perforation. INVESTIGATION/RESULTS: After stabilization, the patient was taken to the CT which excluded major vascular and organ injuries in the neck but revealed a right rectus sheath haematoma and hemopneumoperitoneum. The patient was taken to the OR. DIAGNOSIS: Cervical exploration revealed a laceration of the thyrohyoid membrane and injury of small vessels. Laparotomy showed hemoperitoneum with hematoma of the rectus muscle and a penetrating injury of the sigmoid colon. No other lesions were found. THERAPY AND PROGRESSION: Primary closure of the thyrohyoid membrane and haemostasis was performed. The sigmoid lesion was sutured and the cavity drained. Haemostasis of the abdominal wall was done with sutures and electrocoagulation. The patient was admitted to the ICU. He progressed well and had an uneventful recovery. He was later referred to a Psychiatric clinic. COMMENTS: Self-inflicted stab wounds are a rare form of suicide, accounting for about 2% and occur mostly in men. Penetrating abdominal wounds in this context are rarely lethal, if treated in time, but may require exploratory laparotomy. The management of PNI has followed a 3-zone division. The decision for intervention in zone 2 injuries depends on the patient&quot;s status and associated lesions. REFERENCES: Karačić A, Vojvodić B. Abdominal Self-Stabbing: An Uncommon Type of Sharp Abdominal Trauma. Case Rep Emerg Med. 2021;2021:9917040; Sgardello SD, Christodoulou M, Abbassi Z. Anatomy of a Suicide: A Case Report. Am J Case Rep. 2019;20:1801-1804No.

Emergency laparotomy in abdominal trauma patients – A national study

Background: Abdominal injuries constitute 7–9% of hospitalized trauma patients, with two-thirds suffering severe injuries. Damage control principles, including emergency laparotomy, can be vital for the survival of patients in extremis. This study aims to investigate epidemiological aspects and outcomes in abdominal trauma patients undergoing emergency laparotomy on a national level. Methods: A population-based, nationwide, prospective registry collection of observational data from the Norwegian Trauma Registry. Retrospective analyses of data in patients with an Abbreviated Injury Scale (AIS) code for abdominal injury surgically treated with an emergency laparotomy between January 2015 and December 2020 are presented. Results: Among the 4520 patients with abdominal injuries, 328 patients (7.3%) had an emergency laparotomy, including 20 children. The crude incidence rate of an emergency trauma laparotomy in Norway is 1 per 100.000 per year. Male patients accounted for 72% (n=236), and were younger than women, with a median age of 35 vs 47 years(p=0.005). The median ISS was 17. The injury mechanism was penetrating in 52% (n=172), with stab wounds accounting for 48% (n=156) of the emergency laparotomies. Transport-related accidents caused 33% (n=107) and fall injuries 12% (n=38). Overall 30-day mortality was 6.7% (n=22) after emergency laparotomy, 36% (n=8) from penetrating injury. One child died. The median ISS was 30 in the deceased, with a median probability of survival of 0.37, according to TRISS. Bleeding was the leading cause of death (n=9). Conclusion: Emergency laparotomies for abdominal trauma in Norway is dominated by young males, with an even contribution of blunt and penetrating mechanisms. The mortality is low, predominately after blunt injury.No

Abdominal injuries caused by interpersonal violence in Norway

Introduction: Abdominal injuries account for around 7% of all trauma patients. The frequency of such injuries caused by interpersonal violence is largely unknown. This study aims to investigate epidemiological factors and outcome in traumatic injuries to the abdomen caused by intentional violence on a national level. Material &amp; Methods: This is a population-based, retrospective analysis of data from the Norwegian Trauma Registry between January 2015 and December 2020. Patients with Abbreviated Injury Scale (AIS) code for abdominal injury caused by interpersonal violence were included. Data on injury mechanism, injury severity and mortality are presented. Results: A total of 4520 patients had abdominal injuries of whom 321 (7.1%) were subject to interpersonal violence. 83% of the patients were male (N=267) and the median age of all patients was 34 years. Median Injury Severity Score (ISS) was 6 and median New Injury Severity Score (NISS) was 9. Severe injuries defined as ISS &gt; 15 was present in 26% of the patients (N=83). Penetrating trauma was the dominant assault mechanism in 73% of the patients (N=235). We found that 69.5% (N=223) of the patients presented with stab injuries, 3.7% (N=12) with gunshot injuries and 23.1% (N=74) with blunt force injuries. Damage control laparotomy and damage control thoracotomy was performed in 27% (N=87) and 1.9% (N=6) of the patients, respectively. In 38% of the patients (N=122), no urgent intervention was performed in the emergency department before definite treatment. 3 patients were declared dead by arrival to the hospital, 2 after gunshot injuries and 1 after stab injuries. The overall 30-day mortality rate was 3% (N=10). Conclusion: Interpersonal violence is a relative infrequent cause of traumatic abdominal injury in Norway. The majority of the patients are male and the assault mechanism is primarily penetrating trauma with knives or other sharp objects. The mortality rate is fortunately low.Nothing to declare.

Traumatic retroperitoneal injury: Less is more

A 25-year-old male patient presented to the Emergency Department in context of thoracic and abdominal trauma, due to blunt trauma caused by machine compression at work. His past medical history was irrelevant. Patient's symptoms were not severe. On physical exam, his vital signs were stable, with complains of upper left quadrant pain but no peritoneal signs. A CT scan showed a complete laceration of the proximal region of the head of the pancreas, with no free fluid.(Fig.1) Conservative treatment was decided. On the 3rd day of hospitalization, MRI scan was performed, revealing 2 pancreatic fractures with an imperceptible Wirsung duct in practically the entire pancreas, probably collapsed, calling into question the hypothesis of sectioning.(Fig.2) Between the two fractures, there is a segment of necrotic pancreas with no contrast uptake. The patient remained asymptomatic, analytical and imaging favorable evolution. After 5 months, MRCP showed a scar in the body of the pancreas, with no collections. Pancreatic trauma without injuries to other organs is uncommon and the integrity of the main pancreatic duct is the crucial point in the management and outcome of this patients. Pancreas injuries are divided into 5 grades using the Pancreas Organ Injury Scale by the American Association for the Surgery of Trauma. Severe injuries, evidence of ductal disruption, or hemodynamic instability require emergent surgical intervention. In contrast, conservative management demand close monitoring and regular reassessment to detect any deterioration or complications that may need a change in the treatment plan. We present a case of a Grade III pancreatic trauma in a stable and very young patient, treated conservatively, with the possibility of emergency surgery if necessary. In conclusion, conservative treatment plays a crucial role in the conduct of pancreatic trauma, aiming to preserve pancreatic function while minimizing the risks associated with surgical interventions.No.

Poster session 17
Visceral trauma 4

Appointment

Chairs

Topic

Programme

Poster session 17Visceral trauma 4

Appointment

Chairs

Topic

Programme

Poster session 17
Visceral trauma 4