Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Management of Traumatic Pancreas Injury in Korea: Literature Review

한국에서 외상성 췌장 손상의 치료에 대한 문헌 고찰

  • Lee, Seung Hwan (Department of Surgery, Yonsei University College of Medicine) ;
  • Jang, Ji Young (Department of Surgery, Yonsei University College of Medicine) ;
  • Shim, Hongjin (Department of Surgery, Yonsei University Wonju College of Medicine, Wonju Severance Christian Hospital) ;
  • Lee, Jae Gil (Department of Surgery, Yonsei University College of Medicine)
  • 이승환 (연세대학교 의과대학 외과학교실) ;
  • 장지영 (연세대학교 의과대학 외과학교실) ;
  • 심홍진 (연세대학교 원주의과대학 외과학교실) ;
  • 이재길 (연세대학교 의과대학 외과학교실)
  • Received : 2013.08.26
  • Accepted : 2013.09.09
  • Published : 2013.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Traumatic pancreas injuries are rare conditions that result in high morbidity and mortality. Thus, early diagnosis and intervention are very important to manage pancreatic injuries. The purpose of this study is to review the management and outcomes of the pancreatic injuries in the Korean population. Methods: Original articles published from January 2001 to December 2012 and addressing the Korean population were selected by using indices such as 'pancreas injury', 'traumatic pancreas injury', and 'pancreatic trauma' to search KoreaMed and PubMed. Nine reports were selected to review the management options for surgery or endoscopic retrograde cholangio-pancreatography. We assessed the injury mechanisms, injury severities, associated injuries, types of operation, and outcomes. Results: Two hundred fifty of the 332 patients included in the 9 selected reports were men, and the mean age of all patients was 36.4 years. The main injury mechanism was traffic accidents(65.6%). Most patients had grade II or III injuries(68.9%). The most common extra-pancreatic injury site was the liver, followed by the chest and spleen. Operative management, including distal pancreatectomies(129), drainage procedures(64), pancreaticoduodenectomies(23), and others(60), was used for 276 patients. The reported mortality rate was 10.2%, and the morbidity rate ranged from 38% to 76.9%. The average length of hospital stay was 39.5 days. Risk factors for mortality were amount of transfusion, injury severity, base deficit, age, and presence of shock. Conclusion: In this study, we found neither significant data nor a consensus. If national guidelines are to be developed and established, a national data bank or registry, and nationwide data collection are required.

Keywords

References

  1. Cogbill TH, Moore EE, Morris JA, Jr., Hoyt DB, Jurkovich GJ, Mucha P, Jr., et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31: 1600-6. https://doi.org/10.1097/00005373-199112000-00006
  2. Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg 1990; 125: 1109-13. https://doi.org/10.1001/archsurg.1990.01410210035004
  3. Asensio JA, Demetriades D, Hanpeter DE, Gambaro E, Chahwan S. Management of pancreatic injuries. Curr Probl Surg 1999; 36: 325-419. https://doi.org/10.1016/S0011-3840(99)80003-3
  4. Vasquez JC, Coimbra R, Hoyt DB, Fortlage D. Management of penetrating pancreatic trauma: an 11-year experience of a level-1 trauma center. Injury 2001; 32: 753-9. https://doi.org/10.1016/S0020-1383(01)00099-7
  5. Sharpe JP, Magnotti LJ, Weinberg JA, Zarzaur BL, Stickley SM, Scott SE, et al. Impact of a defined management algorithm on outcome after traumatic pancreatic injury. J Trauma Acute Care Surg 2012; 72: 100-5.
  6. Rogers SJ, Cello JP, Schecter WP. Endoscopic retrograde cholangiopancreatography in patients with pancreatic trauma. J Trauma 2010; 68: 538-44. https://doi.org/10.1097/TA.0b013e3181b5db7a
  7. Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL. Management of blunt major pancreatic injury. J Trauma 2004; 56: 774-8. https://doi.org/10.1097/01.TA.0000087644.90727.DF
  8. Jeong My, Kim Yh, Kyoung Kh, Lee SK, Hong Sk. The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Treatment of Traumatic Pancreas Injury. J Korean Soc Traumatol 2011; 24: 136-42.
  9. Lee PH, Lee SK, Kim GU, Hong SK, Kim JH, Hyun YS, et al. Outcomes of hemodynamically stable patients with pancreatic injury after blunt abdominal trauma. Pancreatology 2012; 12: 487-92. https://doi.org/10.1016/j.pan.2012.09.006
  10. Scollay JM, Yip VS, Garden OJ, Parks RW. A populationbased study of pancreatic trauma in Scotland. World J Surg 2006; 30: 2136-41. https://doi.org/10.1007/s00268-006-0039-z
  11. Farrell RJ, Krige JE, Bornman PC, Knottenbelt JD, Terblanche J. Operative strategies in pancreatic trauma. Br J Surg 1996; 83: 934-7. https://doi.org/10.1002/bjs.1800830715
  12. Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF, Jr., Malangoni MA. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg 1997; 63: 598-604.
  13. Fleming WR, Collier NA, Banting SW. Pancreatic trauma: Universities of Melbourne HPB Group. Aust N Z J Surg 1999; 69: 357-62. https://doi.org/10.1046/j.1440-1622.1999.01572.x
  14. Thomas H, Madanur M, Bartlett A, Marangoni G, Heaton N, Rela M. Pancreatic trauma--12-year experience from a tertiary center. Pancreas 2009; 38: 113-6. https://doi.org/10.1097/MPA.0b013e31818d92d7
  15. Kao LS, Bulger EM, Parks DL, Byrd GF, Jurkovich GJ. Predictors of morbidity after traumatic pancreatic injury. J Trauma 2003; 55: 898-905. https://doi.org/10.1097/01.TA.0000090755.07769.4C
  16. Cogbill TH, Moore EE, Kashuk JL. Changing trends in the management of pancreatic trauma. Arch Surg 1982; 117: 722- 8. https://doi.org/10.1001/archsurg.1982.01380290168030
  17. Stawicki SP, Schwab CW. Pancreatic trauma: demographics, diagnosis, and management. Am Surg 2008; 74: 1133-45.
  18. Cerwenka H, Bacher H, El-Shabrawi A, Kornprat P, Lemmerer M, Portugaller HR, et al. Management of pancreatic trauma and its consequences--guidelines or individual therapy? Hepatogastroenterology 2007; 54: 581-4.
  19. Wolf A, Bernhardt J, Patrzyk M, Heidecke CD. The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc 2005; 19: 665-9. https://doi.org/10.1007/s00464-003-9276-5
  20. Hwangbo SM, Kwon YB, Yun KJ, Kwon HJ, Chun Jm, Kim SG, et al. Clinical Analysis of Traumatic Pancreatic Injury. J Korean Soc Traumatol 2011; 24: 68-74.
  21. Lee HT, Kim JI, Choi PW, Park JH, Heo TG, Lee MS, et al. Clinical Outcomes and Risk Factors of Traumatic Pancreatic Injuries. J Korean Soc Traumatol 2011; 24: 1-6.
  22. Hwang SY, Choi YC. Prognostic Determinants in Patients with Traumatic Pancreatic Injuries. J Korean Med Sci 2008; 23: 126-30. https://doi.org/10.3346/jkms.2008.23.1.126
  23. Yoo SB, Cho MS, Bae KS, Kang SJ. E ffectivness of Opera t i ve Management and Endoscopic Placement Transpapillary Stent in Pancreatic Trauma. J Korean Soc Traumatol 2004; 17: 125-30.
  24. Yang SH, Mun YS, Kwon OS, Lee MK. Experience with Blunt Pancreatic Trauma at Eulji University Hospital. J Trauma Inj 2012; 25: 261-6.
  25. Jang H, Shim HJ, Cha SW, Lee JG. Management of Traumatic Pancreas Injury in Multiple Trauma: Single Center Experience. J Korean Soc Traumatol 2011; 24: 111-7.
  26. Patton JH, Jr., Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, et al. Pancreatic trauma: a simplified management guideline. J Trauma 1997; 43: 234-9; discussion 9-41. https://doi.org/10.1097/00005373-199708000-00005
  27. Kang HJ, Choi SB, Choi SY. Surgical experience and clinical outcome of traumatic pancreatic injury. Korean J Hepatobiliary Pancreat Surg 2012; 16: 160-6.
  28. Kim DH, Jo HJ, Jeon TY, Sim MS. Clinical Review of Traumatic Pancreatic Injuries. Korean J Hepatobiliary Pancreat Surg 2001; 5: 137-45.