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Magnitude, Severity, and Outcome of Traumatic Pancreatic Injury at a Level I Trauma Center in India
Amit Gupta1, Subodh Kumar1, Sanjay Kumar Yadav1
1Department of Surgery, JPN Apex Trauma Center, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029 India.
Insights
Pancreatic injuries are rare but serious trauma complications. Prompt diagnosis and appropriate management, often surgical for severe cases, are crucial to reduce high morbidity and mortality rates.
Area of Science:
- Trauma Surgery
- Surgical Gastroenterology
- Abdominal Trauma Management
Background:
- Pancreatic injury is an uncommon yet critical diagnosis in abdominal trauma.
- Missed pancreatic injuries significantly increase patient morbidity and mortality.
- Understanding the burden and outcomes of pancreatic injury is vital for improving patient care.
Purpose of the Study:
- To determine the prevalence and outcomes of pancreatic injuries.
- To analyze the mechanisms, grading, and management strategies for pancreatic trauma.
- To evaluate the complications and mortality associated with pancreatic injuries.
Main Methods:
- Retrospective analysis of 53 patients with pancreatic injury.
- Data collected from January 2008 to March 2012 at a major trauma center.
- Inclusion criteria: patients admitted with pancreatic injury.
Main Results:
- Pancreatic injuries occurred in 1.18% of trauma admissions, predominantly from blunt abdominal trauma (92.45%) due to road traffic accidents (71.70%).
- Grade III injuries were most common (47%). Nonoperative management was used in 18.86%, while 81.13% required operative intervention.
- Complications occurred in 43.40% and mortality was 20%. Distal pancreatectomy with spleen preservation was the most frequent procedure.
Conclusions:
- Pancreatic injury, though rare, demands timely diagnosis to mitigate severe outcomes.
- Low-grade injuries with an intact main pancreatic duct (MPD) may be managed nonoperatively.
- High-grade injuries necessitate surgical intervention; distal pancreatectomy with spleen preservation is preferred for distal injuries, while Whipple resection is reserved for complex cases with high mortality.
Abstract:
Pancreatic injury is an uncommon and frequently missed injury in abdominal trauma patients. However, missed pancreatic injury is associated with significant morbidity and mortality. This study was conducted to know the burden of pancreatic injury and its outcome in our setup. A retrospective analysis of 53 patients with pancreatic injury from January 2008 through March 2012 at the Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi. Pancreatic injuries were present in 1.18 % of all trauma admissions. Blunt trauma to the abdomen (n = 49, 92.45 %) due to road traffic injury (n = 38, 71.70 %) was the most common mechanism of injury. Isolated pancreatic injury was present in eight (15.09 %) patients. Grade III pancreatic injury (n = 25, 47 %) was the most common. Of these patients, 18.86 % were managed nonoperatively and 81.13 % were managed operatively. Among the operatively managed patients (n = 43), 74.4 % were operated due to pancreatic injury and 25.5 % were operated due to associated injuries. Distal pancreatectomy with or without spleen preservation (n = 25) was the most common operative procedure done. Three out of five patients of Whipple operation for pancreatic injury died. Pancreatic injury was associated with complications in 43.40 % and death in 20 % (n = 11). Pancreatic injury is rare, but delay in diagnosis of pancreatic injury has been associated with higher morbidity and mortality. Low-grade pancreatic injury with intact main pancreatic duct (MPD) could be successfully managed nonoperatively, whereas in high-grade pancreatic injury, an operative intervention is invariably necessary. Distal pancreatectomy with spleen preservation is a desirable goal whenever possible for distal transaction of the pancreas. Whipple resection should be reserved only for hemodynamically stable patients with complex pancreaticoduodenal injury and is associated with high mortality.
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