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Pancreatic trauma: a simplified management guideline
J H Patton1, S P Lyden, M A Croce
1Department of Surgery, University of Tennessee, Memphis, USA.
The Journal of Trauma
|August 1, 1997
Summary
A simplified approach to managing pancreatic injuries, even those with unclear ductal status, resulted in low patient morbidity and mortality. This conservative strategy avoids unnecessary invasive procedures like pancreatography.
Area of Science:
- Trauma Surgery
- Surgical Management
- Gastrointestinal Surgery
Background:
- Recent literature suggests a conservative trend in managing pancreatic injuries.
- Some advocate for pancreatography to define ductal integrity, influencing treatment decisions.
- This study evaluates a simplified 5-year management protocol for pancreatic injuries.
Purpose of the Study:
- To assess the efficacy of a simplified management protocol for all pancreatic injuries.
- To determine if a conservative approach impacts morbidity and mortality rates.
- To evaluate the management of pancreatic injuries with indeterminate ductal status.
Main Methods:
- Retrospective analysis of patients with pancreatic injuries.
- Inclusion criteria: patients surviving over 12 hours post-injury.
- Data collected on treatment strategies and outcomes.
Main Results:
- 134 patients identified; 124 analyzed. Overall mortality 13%, pancreatic-related mortality 2%.
- 37 proximal injuries treated with drainage alone had 11% morbidity.
- 87 distal injuries: 24 resections (high duct injury probability), 30 drainage (low probability). Morbidity was similar between distal groups, regardless of ductal status.
Conclusions:
- A simplified management protocol is effective for pancreatic injuries, including those with indeterminate ductal status.
- This approach achieves low morbidity and mortality.
- Avoidance of routine pancreatography is feasible within this protocol.