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Late complications of pancreatic trauma
N D Carr1, S J Cairns, W R Lees
1Department of Gastroenterology, Middlesex Hospital, London, UK.
Insights
Pancreatic trauma sequelae often involve main pancreatic duct injury. Specialist evaluation is crucial before surgical intervention for these rare, complex cases.
Area of Science:
- Gastroenterology
- Surgical Traumatology
- Pancreatic Surgery
Background:
- Pancreatic trauma is infrequent, leading to limited management experience.
- Sequelae of pancreatic injury can present months after the initial event.
- Previous operations are common in patients with chronic pancreatic trauma complications.
Purpose of the Study:
- To describe lessons learned from investigating and treating patients with pancreatic trauma sequelae.
- To identify the common pathologies associated with non-resolving pancreatic trauma.
- To emphasize the importance of specialist evaluation prior to surgical management.
Main Methods:
- Retrospective review of 11 patients with pancreatic trauma sequelae.
- Diagnostic modalities included endoscopic retrograde cholangiopancreatography (ERCP), ultrasonography, and surgical exploration.
- Treatment strategies involved non-operative management, distal pancreatectomy, and pancreaticoduodenectomy.
Main Results:
- Ten of 11 patients had main pancreatic duct strictures or disruptions.
- Distal pancreatectomy yielded satisfactory results in eight patients.
- Complications arose from unsuspected ductal injury and post-operative pancreatitis.
Conclusions:
- Non-resolving pancreatic trauma sequelae are strongly linked to main pancreatic duct injury.
- Specialist investigation is essential for accurate diagnosis before surgical intervention.
- Management requires careful consideration of ductal integrity and potential complications.
Abstract:
Pancreatic trauma is rare and experience concerning its management is consequently limited. Lessons learnt in the investigation and treatment of a group of 11 patients (median age 28.0 years, range 14-44 years), who presented with the sequelae of trauma, are described. These patients were referred to a centre with an interest in pancreatic disease at a median time of 6.0 months (range 1.5-34 months) after blunt (n = 9) or penetrating (n = 2) injury to the pancreas. Ten of the 11 patients had undergone either single (n = 4) or multiple (n = 6) previous operations. Ten of the 11 patients had either strictures or disruptions of the main pancreatic duct demonstrated by endoscopic retrograde cholangiopancreatography (ERCP) and ultrasonography (n = 8) or by exploration of the pancreas (n = 2). Satisfactory results were achieved by non-operative treatment in one patient and by distal pancreatectomy in eight. One further patient, who underwent distal pancreatectomy, later required completion resection because of unsuspected ductal injury in the head of the gland. The final patient continued with symptoms of pancreatitis after pancreaticoduodenectomy. It is concluded that the non-resolving sequelae of pancreatic trauma are associated with injury to the main pancreatic duct and that specialist investigation should be performed before surgical intervention is contemplated.