Blunt pancreatic duct injury in children
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Abstract:
A 10-year-old boy sustained a blunt injury to the pancreatic neck with complete transection of the main pancreatic duct. Because endoscopic catheterization across the rupture site was not possible, an endoscopic nasopancreatic drain was inserted through the proximal pancreatic duct into the retroperitoneum. An emergency laparotomy was carried out, during which time the tube was used as a guide for identifying disrupted pancreatic ducts. Damaged tissue was removed, the proximal pancreatic duct was ligated, and a Roux-en-Y distal pancreaticojejunostomy was carried out.The patient was discharged 49 days after surgery.Preoperative catheterization of the transected pancreatic duct is an option for detecting a disrupted main pancreatic duct.Keywords:
Pancreatic injury
Pancreatic injury
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目的 探讨钝性胰腺损伤合并主胰管损伤的早期诊断和合理的外科治疗方法.方法 回顾性分析1995年4月至2005年4月间35例胰腺钝性伤病人的临床资料,其早期诊断和损伤严重度的分级根据术前动态的淀粉酶及影像学检查(特别是动态螺旋CT和MRCP扫描)和早期外科手术的术中发现,就胰腺钝性伤的早期诊断方法、不同的手术处理方式及并发症等进行分析.结果 22例Ⅲ级胰腺损伤病人中,14例行远端胰腺切除术和脾切除术,6例行远端胰腺切除术和保留脾脏手术,2例行单纯胰周引流术.8例Ⅳ级胰腺损伤病人中,2例行远端胰腺切除术和脾切除术,2例行胰尾切除术,4例行胰腺空肠Roux-en-Y吻合术.5例Ⅴ级胰腺损伤病人中,4例由于复合伤情较重且合并十二指肠损伤,根据伤害严重度(injury severity score,ISS)评分,首先应用损伤控制手术先进行止血和制止肠内容物的外溢、胰腺外引流等简化手术,于急诊ICU监护待血液动力学稳定后,于受伤后48～72h再次行彻底性手术,1例胰头严重毁损伤行Whipple手术,平均住院时间是40d(2～147d),总死亡率是14.3%(35例中5例),其余均治愈.结论 对胰腺损伤病人,及时正确的诊断和合理的外科手术治疗是减少死亡率,改善预后的重要因素。
Pancreatic injury
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Pancreatic injury is uncommon, accounting for less than 7% of penetrating and 5% of blunt abdominal trauma. Blunt isolated pancreatic trauma in football has been rarely described in the literature and its diagnosis, detection and treatment still remains a challenge. We report a case of a young adult with an isolated complete rupture of the pancreatic body due to a blunt abdominal trauma during a football game. In order to preserve the pancreas and therefore retain function, we performed a terminolateral pancreaticojejunostomy. The postoperative course of the patient was uneventful. The diagnosis of isolated injuries of the pancreas in blunt abdominal trauma can be difficult and challenging and due to the nature of the game physicians should be highly alerted when dealing with football players sustaining abdominal trauma.
Pancreatic injury
Blunt trauma
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Blunt injury to the abdomen is a common surgical emergency which can lead to internal organ injury. Injury to the pancreas, though rare, can lead to significant morbidity and mortality. Diagnosis and management of pancreatic injuries has always been a topic of discussion with several studies done without any fixed results. This study is an analysis of patients with pancreatic injuries and attempts to forward the observations pertaining to surgical management of pancreatic trauma with special reference to complications.
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Blunt trauma
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Objective To explore the diagnosis and treatment of blunt pancreatic injury. Methods A retrospective analysis was done on clinical datum of 10 cases with blunt pancreatic injury from 1999 to 2006. Results In all 10 patients, 9 cases were good recovery, 1 died. Conclusion Blunt pancreatic injury with the low incidence and more complications, early identification is much difficult. Computed tomography (CT) is accurate modality for the diagnosis of blunt pancreatic injury. Selecting appropriate treatment can reduce the rate of death.
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Blunt injury to the pancreas is rare and often eludes diagnosis by physical examination and laboratory evaluation. These Japanese authors reviewed the charts of 73 patients with blunt pancreatic injury to determine the diagnostic value of serum amylase measurements.
Serum amylase …
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The incidence of pancreatic injury is low among trauma cases, and no clear treatment protocol has been established. Pancreatic injury, accompanied by injury to the main pancreatic duct (grades 3, 4 or 5 pancreatic injury) is generally thought to require surgery. Various surgical procedures are proposed for such cases, considering factors such as the patient’s general condition. In recent years, however, several reports have been published indicating that conservative treatment was possible, despite injury of the main pancreatic duct. We treated two cases of pancreatic trauma accompanied by injury to the pancreatic head and main pancreatic duct, and obtained good outcomes with drainage-based treatment. Therefore, we report on these cases along with a review of the literature.
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Conservative Treatment
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Pancreatic injury
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Management of isolated high grade blunt pancreatic injury; case report on lesser aggressive approach
Isolated high grade pancreatic injury is rare after blunt abdominal trauma. It is a rare entity to appreciate intra-operatively and a high index of suspicion should always be kept in mind to reach the diagnosis. We are presenting our experience of four cases with moderate to high grade isolated pancreatic injury which were managed in a lesser aggressive approach and had an uneventful outcome.
Pancreatic injury
Blunt trauma
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