[Pancreatic injuries: diagnosis and management]

Area of Science:

• Gastroenterology
• Trauma Surgery
• Abdominal Imaging

Context:

• Pancreatic trauma is an uncommon but serious injury, accounting for 3-12% of abdominal trauma cases.
• Blunt abdominal trauma is the predominant cause in Central Europe, as evidenced by a Swiss study.
• A review of 75 cases over 10-20 years highlights the challenges in managing these injuries.

Purpose:

• To analyze the management strategies and outcomes of traumatic pancreatic lesions.
• To evaluate the efficacy of conservative versus surgical approaches in blunt pancreatic trauma.
• To identify optimal diagnostic tools and timing for surgical intervention in pancreatic injuries.

Summary:

• The study reviewed 75 pancreatic trauma cases, with 84% resulting from blunt trauma.
• Surgical interventions included caudal resection, pancreatico-jejunal anastomosis, and duodenopancreatectomy, while others underwent drainage.
• Conservative management was employed for 15 hemodynamically stable blunt trauma patients.
• High morbidity (48%) and mortality (5 direct deaths) underscore the severity of pancreatic injuries.
• Diagnostic tools like repeated CT scans and amylasemia are crucial for monitoring.
• Emergency laparotomy is indicated for open abdominal trauma or unstable blunt trauma patients, potentially involving damage control surgery.

Impact:

• Findings guide emergency surgical decisions, emphasizing damage control for unstable patients and conservative approaches for stable ones.
• Highlights the importance of advanced imaging (CT scan) and biochemical markers (amylasemia) in diagnosis and monitoring.
• Informs clinical practice regarding the timing of operative intervention, advocating for delayed surgery only if conditions worsen.