[Pancreatic injury in blunt abdominal trauma: early versus late diagnosis and surgical management]

Abstract

Pancreatic trauma is relatively uncommon, but it has high morbidity and mortality rates, especially when the diagnosis is delayed or inappropriate surgery is attempted. We analysed the management of 11 patients in a university teaching hospital treated with distal pancreatic transsection without (grade II--according AAST score) and with main pancreatic duct (MPD) injury (grade III) caused by blunt abdominal trauma. The average age of the 10 male and 1 female patients was 24.9 years (5-56). Five patients had isolated pancreatic trauma, other 6 patients had 2.3 associated intraabdominal and 0.8 associated extraabdominal injuries. Six patients were diagnosed and operated within the first 24 hours. Five of them had transsection of the gland with main pancreatic duct injury, distal pancreatectomy with (2) or without (1) splenectomy, distal pancreatogastrostomy (1), and (due to associated duodenal laceration) pylorus-preserving pancreatoduodenectomy (1) were performed. In one case (grade II) only external drainage was necessary. All patients in this group who were operated on early survived. Only one patient needed reoperation due to haemorrhage after pancreatoduodenectomy. From the other five patients four were referred after initial treatment in a primary centre (all of them underwent some kind of external drainage), and in one patient the diagnosis of pancreatic injury was missed at the initial operation in our hospital. Three of them had undetected MPD injury, in two patients parenchymal lesions were underestimated or missed. Every patients needed subsequent resection (1), internal drainage due to fistula (2), or drainage of developed abscess (2). Three of them had severe septic and pulmonary complications; one patient with MPD injury died. Patients who require delayed surgery after an unsuccessful period of conservative treatment or a subsequent operation due to undetected MPD injury demonstrated higher pancreas-specific mortality and morbidity rate.