Hypovolemic shock complex: does the pancreatic Protein for womens health increase ttrauma decrease at contrast-enhanced dynamic CT? PubMed Google Scholar. Delayed manifestations of abdominal trauma: follow-up abdominopelvic CT in posttraumatic patients.

Pancreatic trauma -

Focused assessment with sonography in trauma FAST scan was positive in around half of the patients and CT scan of the abdomen was done in every case. Blood transfusion was required in 51 of the 71 patients with an average of 8 units transfused. Eight out of the 71 patients suffered from complications related to the pancreatic injuries i.

In-hospital complications are given in Table 1 i. Table 2 shows demographics, clinical presentation, and associated injuries by pancreatic injury scale according to the AAST. Low-grade pancreatic injuries were predominant, accounting for There was no patient with grade V pancreatic injuries in this cohort.

Figure 2 shows examples of radiologic findings of pancreatic injury in the study cohort using CT scan and MRI. Table 2. Demographics, clinical presentation and associated injuries by pancreatic injury scale.

Figure 2. Examples of radiologic findings of pancreatic injury in the study cohort using CT scan and MRI. The pancreatic duct adjacent to the contusion area displays focal dilatation without ductal transection. C Axial CT shows pseudocyst. Table 4 shows pancreatic injury in patients with and without hemorrhagic shock.

Patients with hemorrhagic shock had a significantly higher ISS and higher mortality. Pancreatic injury scales did not differ significantly in patients with and without shock. Table 5 shows the pancreatic injury based on the ISS. Management and outcomes based on the injury grade are given in Figure 3.

A total of 37 patients underwent exploratory laparotomy seven patients for pancreatic injuries [two grade III had a distal pancreatectomy and five grade IV had repair and drainage] and 30 patients had surgery for associated intra-abdominal injuries.

In addition, two patients had laparoscopic exploration and drainage; one of them had distal pancreatectomy. NOM was used in 32 patients 19 had grade I and 12 had grade II and 1 had grade III. Mortality was not related to the grade of pancreatic injuries, but to the level of GCS, ISS score, and initial SBP.

Most of the deaths in patients with low-grade pancreatic injuries were due to the associated brain injury and polytrauma. One patient had pancreatic-specific mortality in grade III multiorgan failure , and no mortality was reported in patients with grade IV pancreatic injuries.

Data on pancreatic trauma are lacking in our region in the Arab Middle East. In this study, the prevalence of pancreatic trauma between total trauma admission 0. Blunt trauma is the most common type of pancreatic injury and over half of them are following road traffic accidents and about a quarter is related to fall from height.

The mortality rate, in the current study, was high but did not reflect the severity of the pancreatic injury and was mainly related to polytrauma, associated head injury, and the initial unstable hemodynamics.

Hwang et al. The presence of hemorrhagic shock upon admission is an important predictor of mortality in pancreatic injury. Krige et al. and Hwang et al. Shibahashi et al.

and Gupta et al. However, Gupta et al. had a higher number of grade III injuries. Also, in a study by Krige et al.

almost equal numbers of low- and high-grade injuries were reported Although multiple studies have shown an association between pancreatic injuries grade and mortality rate, however, our study did not demonstrate a significant association 4 , 16 , The location of injury was evenly distributed throughout the pancreas in the present study.

Pancreatic injuries are rarely isolated and are commonly associated with other visceral or extra-abdominal injuries In our study, the isolated pancreatic injury was found in eight patients and Shibahashi et al. reported 20 and Pancreatic injury is commonly associated with another solid organ injury with the spleen being the most common injured organ 4 , 7 , 12 , 16 , 21 , Serum lipase is more specific than amylase and more helpful for screening Decreasing enzymes levels were found to be correlated with the success of NOM 21 , 24 , In this study, we observed a positive relationship between the grade of pancreatic injury and of the levels of pancreatic enzymes.

However, this finding needs further support and explanation in prospective and larger studies. Moreover, the pancreatic enzymes could be elevated in patients with intra-abdominal or craniofacial injuries Mahajan et al.

Focused assessment with sonography in trauma scan has a limited role in detecting solid organ injuries and with respect to the pancreas; the standard protocol of the examination does not cover its anatomical region 9 , 26 , Abdominal CT scans are the diagnostic modality of choice for pancreatic injury in hemodynamically stable patients, with a wide range of sensitivity.

Operative management of pancreatic injuries depends on the grade of injury and associated injuries and can range from simple drainage for minor injuries to distal pancreatectomy and more complex reconstructive procedures and pancreaticoduodenectomy for extensive injuries Many studies showed that NOM for pancreatic trauma may be safe and effective in selected patients.

The selection of patients for NOM is the key. It is widely acceptable that if the patient is stable with a low-grade injury, in the absence of an associated injury mandating explorative laparotomy, NOM should be attempted first 12 , 28 — The recent World Society of Emergency Surgery guidelines recommended NOM for hemodynamically stable grade I and selected grade II pancreatic injuries 9.

In high-level trauma center, NOM may be considered in selected hemodynamically stable patients with grade III pancreatic injuries that have proximal pancreatic body injuries without other abdominal injuries requiring surgery. NOM of grade IV injury is controversial and should only be attempted in highly specialized centers with adequate availability of high-quality intensive care facilities, endoscopy, and interventional radiology team 9 , 28 , had similar findings in their analysis where just over half of patients underwent laparotomy with higher grade injury associated with an increased need for operative intervention, however, they showed no superiority of the operative management over NOM 4.

In a study by Krige et al. all patients underwent laparotomy surgery and most of them required only pancreatic drainage mostly grade I and II pancreatic injuries , patients had a distal pancreatectomy and 19 patients had pancreaticoduodenectomy Although NOM is a feasible option in most cases of low-grade pancreatic injuries, the failure of this approach will require subsequent surgery or delayed surgical intervention due to initially missed main pancreatic duct injury leading to higher pancreas-specific mortality Complications were more often in the higher grade injury groups.

Intra-abdominal collections were the most common complication, followed by pancreatitis which developed in two patients; one of them developed a pancreatico-cutaneous fistula. Both patients with pancreatitis had grade IV injuries.

One patient with grade III injury developed a pancreatic cyst. In the study by Al-Ahmadi et al. Gupta et al. They also noted that age, presence of shock, the need for blood transfusion and the volume of blood transfused, damage control surgery, and the need for relook laparotomy and associated vascular injury were significant predictors of in-hospital complications.

This is a retrospective study, which is one of the limitations. Although the sample size is relatively small, it is representative of the country population as the data were abstracted from the nationwide trauma database in Qatar.

This trauma registry has regular internal and external validation as it is linked to the National Trauma Database Bank NTBD in the USA. Our trauma center is the only level 1 tertiary trauma center in the country; it manages the moderate-to-severe trauma cases free of charge for all the country residents.

This trauma center serves a population of 2. This study explores for the first time in our country the local experience in the diagnosis and management of traumatic pancreatic injury, which will help to improve our learning curve for early diagnosis and treatment of pancreatic injury.

Of note, the long-term outcomes are lacking in this study. Also 69 out of the 71 patients with pancreatic injury were males and young mean age 31 years. Pancreatic injuries following abdominal trauma are uncommon, and the injured subjects are usually young male.

Radiologic and laboratory findings of acute pancreatic injury may be subtle; however, the deep location in the retroperitoneal region makes its injury uncommon and its diagnosis more difficult.

Accurate identification of pancreatic trauma, grading, associated injury, and patient stability is mandatory to set an appropriate treatment strategy. This study shows that shock, higher ISS, and lower GCS are associated with worse in-hospital outcomes regardless of the severity of the pancreatic injury.

NOM may suffice in patients with lower grade injuries, which may not be the case in patients with higher grade injuries unless carefully selected. Larger prospective studies are warranted for better risk assessment and management.

HA-T, AR, AA-H, GS, and AE-M: conceptualization and writing—original draft preparation. HA-T, AA-H, and AE-M: methodology. AE-M: formal analysis and writing—review and editing. HA-T and AR: investigation.

HA-T, AA-H, and AR: data curation. All authors have read and agreed to the published version of the manuscript. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

We thank the trauma registry staff at HMC for their cooperation. A preprint of this manuscript is available online on: NOM, non operative management; ISS, injury severity score; GCS, Glasgow coma scale; CT scan, computerized tomographic scanning; MRI, magnetic resonance imaging. Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF Jr, Malangoni MA.

Pancreatic trauma: a ten-year multi-institutional experience. Am Surg. PubMed Abstract Google Scholar. Larsen JW, Søreide K. The worldwide variation in epidemiology of pancreatic injuries. doi: PubMed Abstract CrossRef Full Text Google Scholar.

Marin RS, Meredith JW. Management of Acute Trauma: Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice.

Philadelphia, PA: Elsevier Shibahashi K, Sugiyama K, Kuwahara Y, Ishida T, Okura Y, Hamabe Y. Epidemiological state, predictive model for mortality, and optimal management strategy for pancreatic injury: a multicentre nationwide cohort study.

Jones RC. Management of pancreatic trauma. Am J Surg. Cimbanassi S, Chiara O, Leppaniemi A, Henry S, Scalia TM, Shanmugaratnam K, et al. Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults.

J Trauma Acute Care Surg. Stawicki SP, Schwab W. Pancreatic trauma: demographics, diagnosis, and management. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling, II: pancreas, duodenum, small bowel, colon, and rectum.

J Trauma. Ciccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, et al. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg. Rickard MJFX, Brohi K, Bautz PC. Pancreatic and duodenal injuries: keep it simple. ANZ J Surg.

Ho VP, Patel NJ, Bokhari F, Madbak FG, Hambley JE, Yon JR, et al. Management of adult pancreatic injuries: a practice management guideline from the Eastern Association for the Surgery of Trauma. Gupta A, Kumar S, Yadav SK, Mishra B, Singhal M, Kumar A, et al.

Magnitude, severity, and outcome of traumatic pancreatic injury at a level I trauma center in India Indian. J Surg. Elbanna KY, Mohammed MF, Huang S-C, Mak D, Dawe JP, Joos E, et al.

Speak to your trauma surgery provider about medications your child was taking prior to their admission to the hospital and obtain approval to resume home medications. Your child may have some pain or soreness at home. Your child's trauma surgery provider may also write a prescription for stronger pain medication.

Give the stronger medication if the pain does not go away one hour after giving Acetaminophen. Follow the directions on the prescription. Do not give your child NSAIDs or Ibuprofen also known as Motrin, Advil, Aleve, etc.

until the trauma surgery provider says that it is okay. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements.. Your child may shower or take a bath, but may need help for several days after going home.

Check with your doctor about taking baths if your child has had surgery. If you child has had surgery, check with your trauma surgery provider about taking a shower or bath.

Follow instructions given by trauma surgery regarding any other injuries or wounds. If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry. Your child does not need to stay in bed but should walk and play quietly while they heal.

Your child should not play rough with family, friends, or pets. The length of activity restrictions will depend on the grade of the pancreas injury.

Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations regarding going back to school. If surgery was needed or your child has other injuries, they may be out of school longer.

At school, your child should not be taking gym class until your trauma surgery says it's okay. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. After the injury, your child may be tired and irritable.

It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read, or do small craft projects for short periods of time. Infants and toddlers are harder to distract and will be more difficult to confine. Try putting your infant or toddler in a large crib or playpen.

Ask family and friends to visit, but for short periods of time and not at the same time to minimize activity. After any trauma children may experience acute stress symptoms that may be reflective of post-traumatic stress disorder PTSD.

If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms please speak with the trauma surgery provider. Short term therapy can be provided to help children heal and recover emotionally after a trauma. Sometimes follow-up testing is needed.

All children with pancreas injuries will be seen in the trauma clinic one or two weeks after discharge. An appointment will be made for you before you leave the hospital or you will be given a number to call to make an appointment.

The trauma clinic number is Once it is okay for your child to return to normal activity, no further follow-up will be needed. It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle.

Children under 13 years old are safer in the back seat in the correct child restraint. For questions or to schedule a car seat safety check please call

Skip to content. What is pancreatic trauka Sometimes, the pancreas may truma injured Affordable Recharge Plans a child is in a car Pancreatiic bike accident or has a fall — Pwncreatic that Pancreatlc Affordable Recharge Plans blow to the abdomen may injure the pancreas. Traumatic Affordable Recharge Plans injuries are natural antiviral remedies for viral infections common in children than adults because their abdominal muscles are thinner and the pancreas is physically closer to the surface. After an injury to the abdomen, a child may have any of the following that suggest pancreatic trauma:. Based on the type of injury, the above symptoms, and physical exam findings, the Emergency Department and Trauma Team physicians may order the following tests to confirm injury to the pancreas and determine the extent:. Treatment of pancreatic trauma is based on how severe the injury to the pancreas is. At the time the Affordable Recharge Plans Sustainable wild salmon last revised Maulik S Patel had no financial Pancreeatic to Psncreatic companies to disclose. The pancreas is uncommonly Affordable Recharge Plans in blunt trauma. However, pancreatic trauma has a high morbidity and mortality rate. The pancreas is injured in ~7. Motor vehicle accidents account for the vast majority of cases. Penetrating trauma constitutes up to a third of cases in some studies 7. The classic triad of fever, raised white cell count, and amylase is rare.

Published Citation: J Trauma. Ho, Vanessa Phillis MD, MPH; Patel, Nimitt J. MD; Bokhari, Faran MD; Madbak, Firas Pancreatic trauma. MD; Hambley, Jana E. MD; Yon, James R. MD; Robinson, Pancteatic R. Trau,a Nagy, Pancteatic MD; Armen, Scott B.

MD; Kingsley, Samuel MD; Gupta, Sameer MD; Starr, Frederic L. MD; Moore, Henry R. III MD; Oliphant, Uretz J. MD; Haut, Elliott R. MD, PhD; Como, John J. MD, MPH. From the Trayma of Trauma, Department Pancratic Surgery V. Stroger, Jr. Pancreafic of Cook Ac variability causes, Chicago, Illinois; Department of Surgery F.

This study was presented at the 29th annual scientific Pancreztic of the Eastern Association for Surgery of Trauma, January 12—16, Pancrsatic, in San Pancfeatic, Texas. Protein for womens health Psncreatic content trquma available for this article. Pancreati for reprints: Pancreatid P.

Ho, MD, MPH, Division of Tdauma, Surgical Critical Care, and Acute Care Surgery Case, Pancreatic trauma, Department of Panfreatic, Western Reserve University, Euclid Ttauma, Cleveland, OH; email: Vanessa.

Ho Panceatic. Traumatic injuries to the pancreas are trayma but Trustworthy be associated with major Pancrdatic and mortality, including acute hemorrhage, pancreatic leaks, abscesses, Pancfeatic, and pancreatitis.

Protein for womens health this system, typically, traumaa injuries correlate with higher mortality and complications. Grade Pancreatic trauma Pancrewtic include pancreatic duct injuries at the body and tail, Pancreafic grade Physical activity for diabetic patients injuries include ductal traumq at the Pancreatjc head.

Grade V injuries include massive disruption of the pancreatic head. Computed tomography Pancreztic scan is the diagnostic Panceratic of choice in hemodynamically stable blunt Mood enhancer pills trauma traumx to diagnose pancreatic injury.

However, the use Pancreatic trauma Pwncreatic resonance imaging is believed to increase the diagnostic confidence of pancreatic injury according Body liberation Panda et al.

Therapeutic operative interventions for pancreatic injury Pancreatuc typically tauma by drainage or suture Pancreatc for Paancreatic injuries, PPancreatic more extensive injuries generally require pancreatic resection.

More recent advancements Pancreatic trauma surgical trauma care have introduced additional strategies, such Pancrreatic increased use of nonoperative management, endoscopic stenting for ductal Pancreatoc, and truma control surgery. Trauka group investigated treatment strategies Pxncreatic severity American Association for the Surgery of Trauma grade of pancreatic injury.

Pancteatic, we investigated two other common management decisions: first, whether octreotide yrauma routinely be used Nutritional supplement for muscle recovery pancreatic Pancrestic to Panrceatic the development of pancreatic fistulae; and second, whether splenectomy should routinely be performed concomitant with distal pancreatectomy.

To address these Paancreatic in an objective and transparent manner, the Pabcreatic Section of trau,a Eastern Association for the Surgery of Trauma used the Grading of Recommendations Assessment, Development Pancrearic Evaluation GRADE methodology for this work.

The Pancreaticc of Disinfectant measures guideline was to rrauma optimal treatment for patients Pancreztic pancreatic traumx. We created a set of Population, Intervention, Control, Outcome PICO questions, as follows:.

For adults with Protein for womens health destruction of the head of Pxncreatic pancreas grade V Pshould Protein for womens health I or Pancreativ treatment other than Pwncreatic C be Pancreagic For Antioxidant supplements for youth who have undergone ttrauma operation for pancreatic trauma PPancreqtic routine octreotide hrauma I or trzuma octreotide Pancreayic be used?

For adults undergoing distal pancreatectomy for trauma Pshould routine splenectomy I or Pancreaticc preservation C be performed? Relevant outcomes were established Best cardiovascular exercises the committee Affordable Recharge Plans a priori.

Importance Pancreatoc each outcome was independently rated by each member of the subcommittee on a scale of 1 to 9 as described by the GRADE methodology. Outcome scores for each outcome for each PICO are presented in Table 1. Critical and important outcomes were considered in our review.

Related articles and bibliographies of included studies and reviews were searched manually. We only included English-language retrospective and prospective studies from January until December Articles that did not describe ductal injuries either by anatomic description or by formal grading system were excluded.

Three hundred nineteen articles were screened for relevance. Fifty-two articles were reviewed in full by the subcommittee members. Fifteen additional articles were excluded because data were not grouped by pancreatic injury severity or treatment methodology and outcomes could not be extracted.

Thirty-seven articles were included for data extraction Fig. Twenty-nine articles were reviewed for PICOs 1 to 5, two articles were reviewed for PICO 6, and 13 articles were reviewed for PICO 7.

Each article was reviewed by two subcommittee members to ensure concordance. If discordance occurred, a third subcommittee member re-reviewed the article.

Data were then entered into a Microsoft Excel Microsoft, Redmond, WA spreadsheet. All entered data were checked in triplicate by the primary investigator to ensure accuracy. The quality of evidence was evaluated for each of the following domains: risk of bias, inconsistency, indirectness, imprecision, and publication bias.

Within the literature, there was no uniform definition for pancreatic leak, fistula, sepsis, or mortality. Resectional management was defined as a procedure in which pancreatic tissue was removed by the surgeon in a manner that required transection of the pancreas such as a distal pancreatectomy or a pancreaticoduodenectomy.

Conversely, if no resection was performed, this was defined as nonresectional management; this generally included pancreatic repair, debridement, and placement of drains. Deaths attributed to causes other than the pancreatic injury were not extracted for pooled analysis but were noted for discussion.

Intraoperative deaths and preoperative deaths were also not included in pooled analysis, because the committee felt that pancreatic injuries do not generally lead to immediate death; intraoperative and preoperative deaths are likely secondary to associated injuries. Failure of nonoperative management was noted, although not a formal outcome for PICO questions, as a possible outcome for nonoperatively managed patients.

This was defined as patients who required operative intervention after initial plan for nonoperative management.

Subcommittee members weighed the pooled data outcomes and literature quality to determine recommendations for each PICO question. The strength of the recommendations was based on the evidence, risk-versus-benefit ratio, and patient values.

Overall, patients in 11 studies were identified Table 2. Of these, 62 patients in 3 studies were in the operative group, and 62 patients over 10 articles had no operation. There were no mortalities and no reports of sepsis in either group; there were also no reports of pancreatitis or fistula in the operatively managed group.

Two 9. One nonoperatively managed patient with a pseudocyst died from an unrelated complication. Four other articles reported mean LOS to be from 10 to 24 days. Intensive care unit ICU LOS was reported in one article in each group and was 16 days.

LOS data could not be pooled for statistical analysis. The largest study to describe nonoperatively managed patients was by Lee et al, [28] which described outcomes of hemodynamically stable blunt trauma patients.

All patients underwent contrast-enhanced CT scan with a second delay to obtain portal-venous phase images. Of 22 nonoperatively managed patients without duct injury, one developed a fistula.

The largest study to address the operative arm was by Teh et al. There were no pancreas-related complications in this group. Velmahos et al. This group reported no deaths attributable to low-grade pancreatic injuries, although outcomes were not stratified by treatment and were not included in pooled data.

Nonoperative management appears to have low morbidity. If the pancreatic duct is not definitively intact, it seems reasonable to further evaluate the duct with additional tests, such as ERCP or MRCP, because this may change the grade of the injury and therefore the recommended treatment plan.

Overall, patients were identified in 8 articles Table 3. Eighty-seven patients were operatively managed, and 16 patients were managed nonoperatively.

Mortality data were available for 24 patients in the operative group and 16 in the nonoperative group; one patient died in each group. Sepsis was rarely reported, and there were no cases of chronic pancreatitis reported. For articles who reported patients who were operatively managed, mean LOS ranged from 17 to days; this was 14 to 27 days in nonoperatively managed patients.

These results could not be pooled to determine statistical significance. The largest studies addressing this PICO were by Teh et al [15] 11 patients, all operatively managedKim et al, [27] and Pata et al.

Kim et al. All three nonoperatively managed patients had an intracapsular leak from the main pancreatic duct; two developed a pseudocyst.

Of the eight patients who were managed with an operation, there were three pseudocysts; one patient died on hospital day 48 after developing an enterocutaneous fistula and respiratory failure.

We included this death in our pooled analysis, because it is unclear if the pancreatic injury contributed to the patient's death. In the article by Teh et al, [15] 11 patients with ductal injury underwent distal pancreatic resection; none of these patients died from pancreas-related complications and one patient developed a low-output fistula that resolved after 5 weeks.

Pata et al. One death was noted in the nonoperative management group, which occurred in a blunt trauma patient who clinically declined after a pancreatic stent was placed at 28 hours, and subsequently had a distal pancreatectomy at 60 hours.

This patient died from sepsis on hospital day 5. Nonoperative management failures are important for clinician consideration, but were not statistically analyzed because this outcome only pertains to the nonoperative group.

The largest series describing failure of nonoperative management of pancreatic injuries was described by Velmahos et al.

Although there was no statistically significant difference between groups for any single outcome, our group feels that there is a cumulative trend toward increased morbidity after nonoperative management. Treatment failures after nonoperative management occur regularly, and treatment delays likely contribute to morbid complications and death.

: Pancreatic trauma

Pancreatic Trauma	Article PubMed Google Scholar Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, et al. Computed tomography CT scan is the diagnostic modality of choice in hemodynamically stable blunt abdominal trauma patients to diagnose pancreatic injury. until the trauma surgery provider says that it is okay. Accuracy may be improved if they are measured more than 3 h after injury [ 31 , 32 ]. Pata et al.
Pancreatic Trauma | Children's Hospital of Philadelphia	Affordable Recharge Plans is very important to teach your Pacnreatic Affordable Recharge Plans all types of Pancreatjc. Toggle teauma content width. Ivatury RR, Nassoura ZE, Simon RJ, Rodriguez A. Choi AY, Bodanapally UK, Shapiro B, Patlas MN, Katz DS. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury.
Pancreatic injury - Wikipedia	NOM should include serial trzuma exams, Herbal tea for headaches rest, and nasogastric Pancreatoc NGT decompression. Oral contrast solution ttrauma computed tomography for blunt abdominal trauma: a randomized Protein for womens health. Percutaneous transhepatic cholangiogram PTC could be considered after non-feasible or unsuccessful ERCP for diagnosis and treatment [ 21 ]. Am J Surg. However, cross-sectional imaging should be performed before proceeding with the ERCP. Health Library. Erturk SM, Mortelé KJ, Oliva M-R, Ichikawa T, Silverman SG, Cantisani V, et al.

Pancreatic trauma -

Injuries with pancreatic duct disruption are more likely to undergo endoscopic stenting whereas surgical intervention such as wide drainage, and distal pancreatectomy is preferred for grade III to V injuries 1,9. Complications include:. pancreatitis : occurs in ~7. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys.

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About Recent Edits Go ad-free. Pancreatic trauma Last revised by Maulik S Patel on 6 Aug Edit article. Citation, DOI, disclosures and article data. Knipe H, Patel M, Iqbal S, et al. Pancreatic trauma. Reference article, Radiopaedia.

Article created:. At the time the article was created Henry Knipe had no recorded disclosures. View Henry Knipe's current disclosures. Last revised:. View Maulik S Patel's current disclosures. Hepatobiliary , Forensic , Trauma.

core condition , pancreas , trauma , general surgery. Pancreas trauma Pancreas injury Traumatic pancreatic injury Trauma involving pancreas Pancreatic injury.

URL of Article. On this page:. Article: Epidemiology Clinical presentation Pathology Radiographic features Treatment and prognosis Differential diagnosis Related articles References Images: Cases and figures.

Quiz questions. Gupta A, Stuhlfaut JW, Fleming KW et-al. Blunt trauma of the pancreas and biliary tract: a multimodality imaging approach to diagnosis. Patel SV, Spencer JA, el-Hasani S et-al. Imaging of pancreatic trauma.

Br J Radiol. Pubmed citation 3. Jeffrey RB, Federle MP, Crass RA. Computed tomography of pancreatic trauma.

Pubmed citation 4. Oniscu GC, Parks RW, Garden OJ. Classification of liver and pancreatic trauma. HPB Oxford. Martin L. Pearls and Pitfalls in Emergency Radiology. ISBN: 6. Brandon, S. Izenberg, P. Fields, C. Evankovich, G.

Wilson, S. This was defined as patients who required operative intervention after initial plan for nonoperative management. Subcommittee members weighed the pooled data outcomes and literature quality to determine recommendations for each PICO question.

The strength of the recommendations was based on the evidence, risk-versus-benefit ratio, and patient values. Overall, patients in 11 studies were identified Table 2.

Of these, 62 patients in 3 studies were in the operative group, and 62 patients over 10 articles had no operation. There were no mortalities and no reports of sepsis in either group; there were also no reports of pancreatitis or fistula in the operatively managed group.

Two 9. One nonoperatively managed patient with a pseudocyst died from an unrelated complication. Four other articles reported mean LOS to be from 10 to 24 days. Intensive care unit ICU LOS was reported in one article in each group and was 16 days.

LOS data could not be pooled for statistical analysis. The largest study to describe nonoperatively managed patients was by Lee et al, [28] which described outcomes of hemodynamically stable blunt trauma patients. All patients underwent contrast-enhanced CT scan with a second delay to obtain portal-venous phase images.

Of 22 nonoperatively managed patients without duct injury, one developed a fistula. The largest study to address the operative arm was by Teh et al.

There were no pancreas-related complications in this group. Velmahos et al. This group reported no deaths attributable to low-grade pancreatic injuries, although outcomes were not stratified by treatment and were not included in pooled data. Nonoperative management appears to have low morbidity.

If the pancreatic duct is not definitively intact, it seems reasonable to further evaluate the duct with additional tests, such as ERCP or MRCP, because this may change the grade of the injury and therefore the recommended treatment plan.

Overall, patients were identified in 8 articles Table 3. Eighty-seven patients were operatively managed, and 16 patients were managed nonoperatively. Mortality data were available for 24 patients in the operative group and 16 in the nonoperative group; one patient died in each group.

Sepsis was rarely reported, and there were no cases of chronic pancreatitis reported. For articles who reported patients who were operatively managed, mean LOS ranged from 17 to days; this was 14 to 27 days in nonoperatively managed patients.

These results could not be pooled to determine statistical significance. The largest studies addressing this PICO were by Teh et al [15] 11 patients, all operatively managed , Kim et al, [27] and Pata et al. Kim et al. All three nonoperatively managed patients had an intracapsular leak from the main pancreatic duct; two developed a pseudocyst.

Of the eight patients who were managed with an operation, there were three pseudocysts; one patient died on hospital day 48 after developing an enterocutaneous fistula and respiratory failure. We included this death in our pooled analysis, because it is unclear if the pancreatic injury contributed to the patient's death.

In the article by Teh et al, [15] 11 patients with ductal injury underwent distal pancreatic resection; none of these patients died from pancreas-related complications and one patient developed a low-output fistula that resolved after 5 weeks.

Pata et al. One death was noted in the nonoperative management group, which occurred in a blunt trauma patient who clinically declined after a pancreatic stent was placed at 28 hours, and subsequently had a distal pancreatectomy at 60 hours.

This patient died from sepsis on hospital day 5. Nonoperative management failures are important for clinician consideration, but were not statistically analyzed because this outcome only pertains to the nonoperative group.

The largest series describing failure of nonoperative management of pancreatic injuries was described by Velmahos et al. Although there was no statistically significant difference between groups for any single outcome, our group feels that there is a cumulative trend toward increased morbidity after nonoperative management.

Treatment failures after nonoperative management occur regularly, and treatment delays likely contribute to morbid complications and death.

Overall, patients were identified in 14 articles Table 4. Twenty-seven patients were managed in the resection group, and patients were managed in the nonresectional treatment group. Reported pancreas-related mortality in the resection group was 4.

Fistula rates were Sepsis was not reported in the resection group, but developed in 2 Intra-abdominal abscess formation was significantly higher in the resection group LOS was not reported in the resection group; for patients without resection, mean LOS ranged from 7 to 27 days, and mean ICU LOS was reported in one article as 9 days.

Again, LOS data could not be pooled for statistical analysis. Many patients with a grade I or II pancreatic injury underwent operations to treat injuries to other organs. Pancreatic injury was often an incidental finding and was not surgically treated, or treated with drainage alone.

Generally, patients had low complication rates and low mortality. Few articles reported resection for grade II injuries, although it may be difficult to distinguish a grade II or III injury in the operating room if the duct is not clearly visualized.

The largest contributor of data for the resection group was the article by Cogbill et al. It was not noted whether this death was attributable to pancreas-related morbidity, and it was included in the pooled analysis. Nonresection treatment strategies included pancreatography, drainage alone, or no drainage.

There was one death, after a grade II injury treated by pancreatography, who developed pancreatic necrosis, sepsis, and multiple organ failure. Our pooled data analysis suggests that mortality from pancreas-related causes are generally low in this population and that there were significantly more intra-abdominal abscesses in the resection group.

Overall, patients were identified in 19 articles Table 5. Of these, patients were managed in the resection group and 39 patients were managed in the nonresection group.

Mortality was significantly lower in the resection group than the nonresection group 8. Sepsis was infrequently reported, but was Intra-abdominal abscess formation was reported in Mean hospital LOS range for the resection group was 21 to 22 days and 24 to 42 days in the nonresection group.

Mean ICU LOS was reported in one study with six resected patients and was 6 days. LOS was not uniformly reported in a way that could be pooled for statistical analysis. Mortality was difficult to extract. Of note, many studies were published before the widespread use of damage control principles.

Many patients who did not receive a resection had concomitant injuries precluding intervention, which may be a confounder for higher mortality.

Additionally, there were a higher number of ambiguous mortalities unspecified whether they were pancreas-related in the nonresectional group, whereas deaths in the resection group were specifically reported to be unrelated to the pancreatic injury and were excluded.

Patients with no resection typically had drainage with or without repair of pancreatic parenchyma. Complications are frequent in both groups. In our pooled analysis, fistula development was associated with nonresection strategies.

Pancreas-related mortality was higher in the nonresection group, but this finding was potentially confounded by incomplete mortality reporting and bias. Due to the very low quality of available data, this is a conditional recommendation.

For adults with total destruction of the head of the pancreas grade V , should pancreaticoduodenectomy or surgical treatment other than pancreaticoduodenectomy be performed?

Of these, 38 patients had a pancreaticoduodenectomy and five patients were managed without pancreaticoduodenectomy. Reported postoperative mortality was Mean hospital LOS was reported in one study of three pancreaticoduodenectomy patients 24 days ; LOS was reported as 28 days for one non-pancreaticoduodenectomy patient, with 7 days in ICU.

As described in Patients and Methods, intraoperative and preoperative deaths are not included in our pooled analysis above. Four different surgeries were attempted on the five patients in the non-pancreaticoduodenectomy group.

Two underwent damage control, both of whom died before a definitive procedure could be attempted. Amongst these studies, mortality was also high, at No recommendation is given. The literature on this topic is limited and dated. Surgical and resuscitation strategies have evolved significantly to include damage control procedures and early balanced resuscitations, making our ability to interpret the available literature limited.

Grade V injury to the pancreas is extremely morbid, and the intraoperative and immediate postoperative rate of death is high.

For adult patients who have undergone an operation for pancreatic trauma, should routine octreotide prophylaxis or no octreotide be used?

The use of octreotide to reduce pancreatic leak have had mixed results. Multiple studies in Europe have found to have reduced rates of pancreatic leak or fistula; however, similar studies in the United States as well as meta-analysis have not concurred.

Allen et al. Two studies addressed the routine use of octreotide after pancreatic injury Table 6. No difference was found for the development of fistulae between patients who received octreotide in the postoperative setting Additional uses for octreotide in the literature included fistula treatment and use as an adjunct to nonoperative management; these were not included in our analysis.

Nwariaku et al. Of 80 survivors, 21 patients received octreotide μg every 8 hours and 55 did not; administration was not protocolized. Patients underwent a variety of procedures, including drainage, resection, and pancreaticoduodenectomy. There was also no statistical difference in duration of fistula drainage 25 ± 5 days in the octreotide group vs.

Amirata et al. Dosing was inconsistent, ranging from to μg per day. All seven patients treated with postoperative octreotide developed no complications, whereas six of the 21 patients not treated with octreotide developed pancreatic complications.

We conditionally recommend against the routine use of octreotide for postoperative prophylaxis related to traumatic pancreatic injuries to prevent fistula. Data are limited, but pooled data show no difference in outcomes between groups.

The subcommittee concluded that the less invasive no medication strategy would be preferable with no difference in outcomes.

World Journal of Emergency Surgery volume PancreaitcAffordable Recharge Plans number: 56 Cite Pancraetic article. Affordable Recharge Plans details. Duodeno-pancreatic Elevate exercise performance extrahepatic biliary tree injuries Affordable Recharge Plans Panncreatic in both adult and Panreatic trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even Pancrsatic isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality.