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Pancreaticoduodenal injuries: re-evaluating current management approaches
1Department of Surgery, King Edward VIII Hospital, University of KwaZulu-Natal, Durban.
Insights
Pancreaticoduodenal injuries are rare but serious. This study found a 23% mortality rate, with most injuries from gunshots. Conservative management is recommended where possible for these trauma cases.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Pancreaticoduodenal injuries are infrequent due to anatomical protection.
- Management strategies vary based on injury severity.
- This study aimed to analyze outcomes and refine treatment approaches.
Purpose of the Study:
- To document the outcomes of patients with pancreaticoduodenal injuries.
- To re-evaluate the current management strategies for these injuries.
Main Methods:
- A prospective study was conducted over 7 years (1998-2004) at a single surgical ward.
- Data collected included demographics, clinical presentation, surgical findings, and patient outcomes.
- Prophylactic antibiotics were administered pre-operatively.
Main Results:
- Out of 488 laparotomies, 43 patients (9%) sustained pancreaticoduodenal injuries, all male.
- Gunshot wounds were the most common mechanism (30 cases), followed by stabbings (10) and blunt trauma (3).
- Complications occurred in 49% of patients, with a 23% mortality rate and a median ICU stay of 4 days.
Conclusions:
- The observed mortality rate is comparable to global data.
- Adequate surgical exploration of the pancreas and duodenum is crucial.
- Conservative operative management should be prioritized when feasible.
Background:
Pancreaticoduodenal injuries are uncommon owing to the protected position of the pancreas and duodenum in the retroperitoneum. Management depends on the extent of injury. This study was undertaken to document outcome of pancreaticoduodenal injuries and to re-evaluate our approach.
Patients And Methods:
A prospective study of all patients treated for pancreaticoduodenal trauma in one surgical ward at King Edward VIII hospital over a 7-year period (1998 - 2004). Demographic data, clinical presentation, findings at laparotomy and outcome were documented. Prophylactic antibiotics were given at induction of anaesthesia.
Results:
A total of 488 patients underwent laparotomy over this period, 43 (9%) of whom (all males) had pancreatic and duodenal injuries. Injury mechanisms were gunshot (30), stabbing (10) and blunt trauma (3). Their mean age was 30.1+9.6 years. Delay before laparotomy was 12.8+29.1 hours. Seven were admitted in shock. Mean Injury Severity Score (ISS) was 14+8.6. Management of 20 duodenal injuries was primary repair (14), repair and pyloric exclusion (3) and conservative (3). Management of 15 pancreatic injuries was drainage alone (13), conservative management of pseudocyst (1) and distal pancreatectomy (1). Management of 8 combined pancreaticoduodenal injuries was primary duodenal repair and pancreatic drainage (5) and repair with pyloric exclusion of duodenal injury and pancreatic drainage (3). Twenty-one patients (49%) developed complications, and 28 required ICU admission with a median ICU stay of 4 days. Ten patients died (23%). Mean hospital stay was 18.3+24.4 days.
Conclusions:
The overall mortality was comparable with that in the world literature. We still recommend adequate exploration of the pancreas and duodenum and conservative operative management where possible.
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