Abstract
Background
Injuries to the pancreas following blunt abdominal trauma are rare due to its protected retroperitoneal position. Many pancreatic lesions remain unnoticed at first and only become apparent when complications arise or during treatment of other injuries. The mortality rate is between 12 and 30%, and if treatment is delayed it is as high as 60%.
Methods
Using medical records over the past 5 years, we investigated when and in what circumstances endoscopic retrograde cholangiopancreaticography (ERCP) was used in the diagnosis and treatment of pancreas injuries after blunt abdominal trauma. Penetrating injuries were not taken into consideration.
Results
An ERCP was performed on a total of five patients with suspected injuries to the pancreas after blunt abdominal trauma. No duct participation could be determined in three of the patients with a first degree pancreatic lesion. A 44-year-old woman sustained severe internal and external injuries after a traffic accident. Because of the nature of her injuries, pancreatic left resection with splenectomy was necessary. After the operation, a pancreatic fistula diagnosed. The ductus pancreaticus (DP) was successfully treated by stenting with the use of endoscopic retrograde pancreaticography. A 24-year old woman was kicked in the epigastrium by a horse. On the day after the incident, she complained of increasing pain in the upper abdomen, and she had elevated amylase and lipase levels. Computed tomography scan showed free fluid. Less than 48 h after the accident, ERCP was performed and a leakage in the DP in the head-body region (fourth degree) was identified. We placed a stent, and during the subsequent laparoscopy the omental bursa was flushed out and a drainage laid. After 14 days, the patient was sent home. We removed the drainage 4 weeks after the accident, and the stent after 12 weeks.
Conclusion
The major advantage of the prompt retrograde discription of the pancreatobiliary system after an accident in which pancreas involvement is suspected is the more precise assessment of the extent of the injuries. If a stent is placed in the same session, it is possible to carry out definitive and interventional treatment.
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References
D Bigattini JH Boverie RF Dondelinger (1999) ArticleTitleCT of blunt trauma of the pancreas in adult Eur Radiol 9 244–249 Occurrence Handle1:STN:280:DyaK1M3gtFylsw%3D%3D Occurrence Handle10101645
GL Carboni MA Rothlin O Trentz (1999) ArticleTitleVerfahrenswahl in der Behandlung von Pankreasverletzungen Unfallchirurg 102 298–304 Occurrence Handle1:STN:280:DyaK1M3otlOksQ%3D%3D Occurrence Handle10355346
RJ Farrell JEJ Krige PC Bornman JD Knottenbelt J Terblanche (1996) ArticleTitleOperative strategies in pancreatic trauma Br J Surg 83 934–937
H Feussner W Papaziogas JR Siewert (1999) ArticleTitleModerne Diagnostik des stumpfen Bauchtraumas Chirurg 70 1246–1254 Occurrence Handle1:STN:280:DC%2BD3c%2FlvFKiug%3D%3D Occurrence Handle10591761
DJ Harrell GC Vitale GM Larson (1998) ArticleTitleSelective role for endoscopic retrograde cholangiopancreaticography in abdominal trauma Surg Endosc 12 400–404 Occurrence Handle1:STN:280:DyaK1c3ktVKitQ%3D%3D Occurrence Handle9569357
M Hata Y Murao T Konobu K Okuchi Y Nakajima (2002) ArticleTitleLaparoscopic treatment for peripheral pancreatic duct injury after blunt abdominal trauma: report of a case Surg Today 32 659–662 Occurrence Handle12111529
K Higashitani T Kondo Y Sato T Takayasu R Mori T Ohshima (2001) ArticleTitleComplete transection of the pancreas due to a single stamping injury: a case report Int J Legal Med 115 72–75 Occurrence Handle1:STN:280:DC%2BD3Mnnsl2qsg%3D%3D Occurrence Handle11724433
SO Ikenberry S Shermann RH Hawes G Smith M.Lehmann (1994) ArticleTitleThe occlusion rate of pancreatic stents Gastrointest Endosc 34 16–18
T Jacobi M Nagel HD Saeger (1997) ArticleTitleVerletzungen des Pankreas Chirurg 68 624–629 Occurrence Handle1:STN:280:ByiA1czkvVI%3D Occurrence Handle9324443
HS Kim DK Lee IW Kim SK Baik SO Kwon JW Park NC Cho BS Rhoe (2001) ArticleTitleThe role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury Gastrointest Endosc 54 49–55 Occurrence Handle1:STN:280:DC%2BD3Mzms1Gkug%3D%3D Occurrence Handle11427841
E Klar M Angelescu G Richter Herfarth Ch (1999) ArticleTitleAktuelle Therapie bei, Verletzungen des hepatobiliopankreatischen Kompartments Ghirurg 70 1255–1268 Occurrence Handle1:STN:280:DC%2BD3c%2FlvFKiuw%3D%3D
CE Lucas (1977) ArticleTitleDiagnosis and treatment of pancreatic and duodenal injury Surg Clin North Am 57 49–65 Occurrence Handle1:STN:280:CSiC2srhtFE%3D Occurrence Handle854854
JM Mayer R Tomaczek B Rau F Gebhard HG Beger (2002) ArticleTitlePancreatic injury in severe trauma: early diagnosis and therapy improve the outcome Dig Surg 19 291–299 Occurrence Handle12207073
EE Moore TH Cogbill MA Malangoni GJ Jurkovic SR Shackford HR Champion JW McAninch (1995) ArticleTitleOrgan injury scaling Surg Clin North Am 75 293–303 Occurrence Handle1:STN:280:ByqB3cjptVM%3D Occurrence Handle7899999
C Rouge’-Maillart A Traqui MC Tortel P Pessaux M Penneau B Ludes (2001) ArticleTitleFatal blunt pancreatic trauma secondary to assault and battery: a case report Int J Legal Med 115 162–164 Occurrence Handle1:STN:280:DC%2BD38%2FkvVeqtg%3D%3D Occurrence Handle11775019
V Schumpelick T Ambacher KP Riesener (1999) ArticleTitleAktuelle Therapie der Verletzungen von Colon und Retroperitoneum Chirurg 70 1269–1277 Occurrence Handle1:STN:280:DC%2BD3c%2FlvFKhsg%3D%3D Occurrence Handle10591763
T Takishima M Hirata Y Kataoka Y Asari K Sato T Ohwada A Kakita (2000) ArticleTitlePancreatographic classification of pancreatic ductal injuries caused by blunt injury to the pancreas J Trauma 48 745–751 Occurrence Handle1:STN:280:DC%2BD3c3ktFGhtg%3D%3D Occurrence Handle10780612
T Takishima K Sugimoto M Hirata Y Asari T Ohwada A Kakita (1997) ArticleTitleSerum amylase level on admission in the diagnosis of blunt injury to the pancreas Ann Surg 226 70–76 Occurrence Handle1:STN:280:ByiA1cvot10%3D Occurrence Handle9242340
JJ Telford JJ Farrell JR Saltzman SJ Shields PA Banks DR Lichtenstein RS Johannes PB Kelsey DL Carr-Locke (2002) ArticleTitlePancreatic stent placement for duct disruption Gastrointest Endosc 56 18–24 Occurrence Handle12085030
GC Timothy D Weinman (2001) ArticleTitleTreatment of pancreatic duct disruption in children by an endoscopically placed stent J Pediatr Surg 36 345–348 Occurrence Handle11172431
B Travers (1827) ArticleTitleRupture of pancreas Lancet 12 384
JG Tyburski CJ Dente RF Wilson C Shanti CP Steffes A Carlin (2001) ArticleTitleInfectious complications following duodenal and/or pancreatic trauma Am Surg 67 227–230 Occurrence Handle1:STN:280:DC%2BD3M7nsFOktg%3D%3D Occurrence Handle11270879
T Zimmermann K Henneking C Kelm W Padberg K Schwemmle (1993) ArticleTitlePankreaspseudozysten nach stumpfen Bauchtraumata Langenbecks Arch Chir 378 102–105 Occurrence Handle1:STN:280:ByyB3szktFM%3D Occurrence Handle8474291
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Wolf, A., Bernhardt, J., Patrzyk, M. et al. The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc 19, 665–669 (2005). https://doi.org/10.1007/s00464-003-9276-5
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DOI: https://doi.org/10.1007/s00464-003-9276-5