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Traumatic Pancreatic Injury Presentation, Management, and Outcome: An Observational Retrospective Study From a Level
Hassan Al-Thani1, Ahmed Faidh Ramzee1, Ammar Al-Hassani1
1Department of Surgery, Trauma Surgery Section, Hamad General Hospital (HGH), Doha, Qatar.
Insights
Pancreatic trauma is rare, affecting young men, with most injuries being low-grade. High injury severity score and low Glasgow Coma Scale predict poor outcomes, guiding management decisions.
Area of Science:
- Trauma Surgery
- Surgical Gastroenterology
- Emergency Medicine
Background:
- Pancreatic traumatic injuries are uncommon but can lead to severe complications.
- Understanding their presentation, management, and outcomes is crucial for trauma centers.
Purpose of the Study:
- To investigate the characteristics, treatment strategies, and patient outcomes associated with pancreatic traumatic injuries.
- To identify factors influencing in-hospital outcomes in patients with pancreatic trauma.
Main Methods:
- Retrospective analysis of patients admitted with pancreatic injuries between 2011 and 2017.
- Data collected from a single level 1 trauma center, including injury grades, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS).
Main Results:
- 71 patients with pancreatic trauma were identified (0.6% of trauma admissions).
- Most patients were young males with low-grade injuries (I-II), but 38% had GCS <9 and 73% had ISS >16.
- Mortality was 31%, associated with high ISS, low GCS, and hemorrhagic shock, irrespective of injury grade.
Conclusions:
- Pancreatic injuries from blunt trauma are rare, typically affecting young males, with predominantly low-grade severity.
- On-admission shock, high ISS, and low GCS are critical predictors of poor outcomes.
- Non-operative management is suitable for lower-grade injuries, while higher-grade injuries require careful selection for non-operative or operative approaches.
Background:
We aimed to study the presentation, management, and outcomes of patients with a pancreatic traumatic injury.
Methods:
We retrospectively analyzed data for all patients who were admitted with pancreatic injuries between 2011 and 2017 at the only level 1 trauma center in the country.
Results:
There were 71 patients admitted with pancreatic trauma (0.6% of trauma admissions and 3.4% of abdominal injury admissions) with a mean age of 31 years. Sixty-two patients had pancreatic injury grade I-II and nine had injury grade III-IV. Thirty-eight percent had Glasgow Coma Scale (GCS) <9 and 73% had injury Severity Score (ISS) >16. The level of pancreatic enzymes was significantly proportional to the grade of injury. Over half of patients required laparotomy, of them 12 patients had an intervention on the pancreas. Eight patients developed complications related to pancreatic injuries ranging from pancreatitis to pancreatico-cutaneous fistula while 35% developed hemorrhagic shock. Mortality was 31% and regardless of the grade of injury, the mortality was associated with high ISS, low GCS, and presence of hemorrhagic shock.
Conclusion:
Pancreatic injuries following blunt trauma are rare, and the injured subjects are usually young men. However, most injuries are of low-grade severity. This study shows that regardless of the pancreatic injury grade on-admission shock, higher ISS and lower GCS are associated with worse in-hospital outcomes. Non-operative management (NOM) may suffice in patients with lower grade injuries, which may not be the case in patients with higher grade injuries unless carefully selected.
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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: