Pancreatic Battlefield Injuries During Ukraine War

Battlefield pancreatic injury (BPI) is rare and difficult to diagnose and treat. Publications on this topic are limited. The aim of this study was to analyze our initial experience in treating BPI since the beginning of the full-scale Russian invasion of Ukraine.

We retrospectively analyzed the medical records of military personnel treated between February and December 2022. XLSTAT's variable characterization tool, using an indicator called test value (TV), was used to assess possible associations between variables.

BPIs were found in 11 of 252 (4.4%) patients with an average age of 36.6 ± 10.1 years. The main cause of injury was explosion (6/11, 54.6%) and gunshot (2/11, 18.2%). Head of pancreas injuries were the most common (5/11, 45.5%), followed by distal pancreas injuries (4/11, 36.4%). Our treatment was predominantly interventional (5/11, 45.5%) and/or surgical drainage (4/11, 36.4%). Two patients (18.2%) were treated conservatively. One patient (9.1%) underwent cystojejunostomy for pseudocyst and another (9.1%) distal pancreatectomy. There was a positive association between the number of frontline operations and concomitant jejunal (TV 2.289; P = .022) and ileal (TV 2.211; P = .027) injuries. There was also a positive association between stoma formation at primary surgery and ileal injury (TV 2.000; P = .045) and pancreatic fistula and concomitant rib fractures (TV 2.484; P = .013).

BPIs would be expected in victims with explosive damage to the upper body, often located in the head of the pancreas. Concomitant small bowel injury and rib fractures are associated with increased frequency of stoma formation, number of primary surgeries, and pancreatic fistula. Most patients can be successfully managed with interventional or surgical drainage without resection.