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Management of pancreatic trauma in urban India: A multicenter study
Devi Bavishi1, Monty Khajanchi1,2, Ramlal Prajapati1
1Seth GS Medical College and KEM Hospital, General Surgery, Mumbai, India.
Insights
Pancreatic trauma management in India showed conservative and surgical approaches were equally common. Most severe injuries (grade III/IV) required surgery, and associated injuries were frequent.
Area of Science:
- Trauma Surgery
- Surgical Management
- Gastrointestinal Surgery
Background:
- Pancreatic trauma affects 0.2-2% of blunt and 1-12% of penetrating trauma cases.
- Associated mortality and morbidity rates are significant, ranging from 9-34% and 30-60% respectively.
- Understanding management strategies is crucial for improving outcomes.
Purpose of the Study:
- To review the management of pancreatic trauma.
- To analyze data from a multicenter database in India.
Main Methods:
- Analysis of patients with pancreatic injuries from the 'Towards Improved Trauma Care Outcomes (TITCO)' study.
- Inclusion of 16047 trauma cases, with 1134 experiencing abdominal trauma.
- Identification of 55 patients with pancreatic injuries.
Main Results:
- Pancreatic injuries occurred in 4.9% of abdominal trauma patients.
- Conservative management (50.9%) and surgical exploration (49.1%) were similarly utilized.
- 82% of patients had associated injuries, most commonly to the thorax, liver, bowel, and spleen.
Conclusions:
- Conservative and operative management are equally prevalent for pancreatic injuries.
- High-grade injuries (III/IV) predominantly received operative treatment.
- The high incidence of associated injuries underscores the complexity of pancreatic trauma management.
Background:
Pancreatic trauma occurs in 0.2-2% of patients with blunt trauma and 1-12% of patients with penetrating trauma. The mortality and morbidity rates range from 9 to 34% and 30-60% respectively. We aimed to review the management of pancreatic trauma in a multicenter database from India.
Methods:
We analyzed all patients who suffered a pancreatic injury and who were included in the multicenter prospective observational study 'Towards Improved Trauma Care Outcomes (TITCO)'.
Results:
Of the 16047 trauma cases, 1134 (7.1%) patients suffered abdominal trauma. Of all those with abdominal trauma, 55 patients (4.9%) had injury to the pancreas. 28 patients (50.9%) with pancreatic trauma were managed conservatively. 27 patients (49.1%) underwent surgical exploration in the form of laparotomies. 11 procedures were undertaken for pancreas. A total of 45 (82%) patients had associated injuries along with pancreatic injury. Thorax (19) (including injuries to lung, pleura and ribs), liver (17), bowel (14) and spleen (13) were the most common associated injuries.
Conclusion:
Conservative management was as common as operative management in patients with pancreatic injuries. Most (80%) grade III/IV underwent operative treatment. Many patients (82%) had associated injuries.
Level Of Evidence:
III.
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