Related Experiment Video
Updated: Jan 1, 2026
Endoscopic Ultrasound-Guided Biliary Drainage: Endoscopic Ultrasound-Guided Hepaticogastrostomy in Malignant Biliary Obstruction
Published on: March 25, 2022
Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines
Federico Coccolini1, Leslie Kobayashi2, Yoram Kluger3
11General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy.
Insights
Injuries to the duodenum, pancreas, and biliary tree are rare but serious. Management depends on injury severity and patient stability, with guidelines from WSES and AAST aiding treatment decisions.
Area of Science:
- Trauma Surgery
- Surgical Gastroenterology
- Emergency Medicine
Background:
- Duodeno-pancreatic and extrahepatic biliary tree injuries are uncommon in trauma.
- These injuries often involve associated trauma due to anatomical proximity.
- High morbidity persists even with isolated injuries, and mortality is linked to associated injuries.
Purpose of the Study:
- To present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) guidelines for managing duodenal, pancreatic, and extrahepatic biliary tree trauma.
Main Methods:
- Guidelines based on hemodynamic stability, clinical presentation, and injury grade.
- Incorporation of endoscopic and percutaneous interventions for non-operative management.
- Consideration of late diagnosis and treatment sequelae.
Main Results:
- Optimal management is guided by patient stability and injury severity.
- Non-operative strategies are increasingly viable with endoscopic and percutaneous techniques.
- Immediate operative intervention is preferred for severe injuries and hemodynamic instability.
Conclusions:
- Timely diagnosis and treatment are crucial to reduce morbidity and mortality.
- Guidelines aim to standardize the management of these complex injuries.
- WSES and AAST provide a framework for optimal care in duodeno-pancreatic and biliary trauma.
Abstract:
Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.
Related Concept Videos
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:29Chronic Pancreatitis II: Collaborative Care
Assessment:
01:26Endoscopic Procedures V: ERCP
Patient...
01:27Acute Pancreatitis I: Introduction
Acute pancreatitis is characterized by rapid inflammation of the pancreas, often caused by factors like gallstone blockage or excessive alcohol consumption. Chronic pancreatitis, on the other hand, is a slow, progressive inflammation that may result from long-term alcohol abuse, obstructions in the pancreatic duct, or genetic factors.
The causes of acute pancreatitis include: