• Journal of Trauma and Injury
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• v.25 no.4
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• pp.261-266
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• 2012

Purpose: Traumatic pancreatic injury is not common in abdominal trauma injury. However, the morbidity and the mortality rates of patients with pancreatic injury, which are related with difficulties of initial assessment, establishment of diagnosis, and treatment are relatively high. The aim of this study is to review our institution's experience and suggest a diagnosis and therapeutic algorithm for use in cases involving traumatic pancreatic injury. Methods: Eighteen(18) patients with blunt pancreatic injury from January, 2004 to October 2012 were included in this study. We analyzed treatment and diagnosis method, other organ injury, treatment interval, hospital stay and complications retrospectively. Results: Nine patients were treated with conservative medication and another nine patients were treated surgically. Complications occurred in nine patients, and one patient died due to intraventricular hemorrhage and subdural hemorrhage with multiple organ failure. Delayed surgery was performed in three cases. The early and delayed surgery groups showed difference in hospital stay and intensive care unit stay. Delayed surgery was associated with a longer hospital stay (p=0.007) than immediate surgery. Conclusion: In blunt pancreatic trauma, proper early diagnosis and prompt treatment are recommended necessity. Based on this review of our experience, we also suggest the adoption of our institution's algorithm for cases involving traumatic pancreatic injury.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• v.20 no.4
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• pp.252-258
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• 2017

Purpose: Blunt trauma of pancreas in children is uncommon and its management varies from observational to early operative intervention. We analysed the feasibility and outcome of non-operative management in all grades of paediatric pancreatic injuries. Methods: A total of 15 patients of pancreatic trauma seen in a Paediatric Surgery Unit were retrospectively analyzed. Results: Age of the patients ranged from 3-11 years (mean, 7.7 years). The mode of injury was local trauma in 9 children. Only 3 patients had associated injuries and all were haemodynamically stable. Serum amylase levels were raised in 12 patients at admission which ranged from 400-1,000 IU. Computed tomography scan made a correct diagnosis in 14 patients. Grades of the injury varied from grade I-V (1, 3, 6, 4, 1 patients respectively). Fourteen patients were managed conservatively. One patient underwent laparotomy for suspected superior mesenteric hematoma. The average duration of enteral feeds was 3.7 days and of hospital stay was 9.4 days. Six patients formed pancreatic pseudocysts; two were managed conservatively while the other four underwent cystogastrostomy. The patients were followed up for a period of 1-12 years. All remained asymptomatic and none had exocrine or endocrine deficiencies. Conclusion: Non-operative treatment for isolated blunt trauma of pancreas in children may be safely followed for all the grades of injury; if associated injuries requiring surgical intervention are ruled out with a good quality imaging and the patients are hemodynamically stable. It did not increase the hospital stay and morbidity and avoided operative intervention on acutely injured pancreas.

• Journal of Trauma and Injury
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• v.29 no.2
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• pp.51-55
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• 2016

Isolated injury to the pancreas after abdominal trauma is uncommon, and a delay in diagnosis and treatment can increase the morbidity and mortality. Therapeutic decisions with respect to pancreatic trauma are usually made based on the site of injury and the status of the pancreatic ductal system. In this report, we describe the surgical management of pancreatic head transection as an isolated injury following blunt abdominal trauma. A 55-year-old man presented with epigastric pain that radiated to the back. Abdominal computed tomography revealed a hematoma in the pancreatic head and upstream dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography showed complete disruption of and contrast leakage from the main pancreatic duct in the pancreatic head region with a nonenhanced upstream duct. Emergency pancreaticoduodenectomy was successfully performed, and the patient was discharged on postoperative day 9 without any complications.

• Advances in pediatric surgery
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• v.9 no.1
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• pp.52-56
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• 2003

A 10 year old boy was admitted with blunt abdominal trauma by bike handle injury. The patient was operated upon for a generalized peritonitis due to pancreaticoduodenal injury. On opening the peritoneal cavity. complete transection of distal end of common bile duct and. partial separation between pancreas head and second portion of duodenum were found. Ligation of the transected end of the common bile duct. T-tube choledochostomy, and external drainage were performed. A pseudocyst was found around the head portion of the pancreas on the 7th postoperative day with CT. An internal fistula had developed between the pseudocyst and ligated common bile duct. The pseudocyst was subsided after percutaneous drainage. In the case of the undetermined pancreatic injury, percutaneous external drainage can be effective in treating the traumatic pancreatic pseudocyst in a pediatric patient.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.310-314
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• 2023

Pancreatic trauma from a blunt injury is fairly uncommon in the pediatric population. Furthermore, such trauma with associated disruption of the pancreatic duct (PD) is even less prevalent and is associated with high morbidity and mortality. Pancreatic injuries in the pediatric population are often missed and hence require a thorough workup in children presenting with any form of abdominal injury. This case report describes a young boy who presented with abdominal pain and did not initially inform medical staff about any injury. For this reason, his initial provisional diagnosis was appendicitis, but he was later found to have transection of the pancreas with injury to the PD on imaging. The management of such injuries in pediatric patients often poses a challenge due to a lack of pediatric physicians trained to perform interventions such as endoscopic retrograde cholangiopancreatography. Furthermore, such interventions carry a higher risk when performed on children due to the smaller size of their pancreatic ducts. As a result, our patient had to be transferred to an adult center to undergo this procedure. Thus, maintaining a high degree of suspicion, along with a detailed history and examination, is crucial for the early diagnosis and management of pancreatic injuries.

• Journal of Trauma and Injury
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• v.36 no.3
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• pp.242-248
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• 2023

Purpose: Blunt pancreatic trauma in pediatric patients is relatively rare, yet it is associated with high risks of morbidity and mortality This study aimed to review pediatric patients with blunt pancreatic trauma treated at a single center and provide treatment guidelines. Methods: This study included patients under the age of 18 years who visited our center's pediatric emergency department and were diagnosed with pancreatic injury due to abdominal trauma via radiological examination between January 2007 and December 2022. Patients' medical records were retrospectively reviewed and analyzed. Results: Among 107 patients with abdominal trauma, 14 had pancreatic injury, with a median age of 8.2 years (interquartile range, 3.1-12.3 years). Eight patients were male and six were female. The most common mechanism of injury was falls from a height and bicycle handlebars (four cases each). Six patients had associated injuries. Two patients had American Association for the Surgery of Trauma grade I or II, eight had grade III, and four had grade IV or V injuries. Eight patients underwent surgical resection, and four were discharged with only an intervention for duct injuries. Conclusions: Patients with blunt pancreatic trauma at our center have been successfully treated with surgical modalities, and more recently through nonsurgical approaches involving active endoscopic and radiologic interventions.

• Journal of Trauma and Injury
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• v.26 no.4
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• pp.266-272
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• 2013

Purpose: Although the duodenum and the pancreas are protected by surrounding organs and have a low probability of injury during trauma, the mortality and the morbidity due to complications is high. This report includes the pancreaticoduodenal injuries we observed that were treated at a single institute. Methods: The medical records of patients admitted to our institute between 2001 and 2012 for pancreaticoduodenal injury were retrospectively reviewed. Results: In our hospital, between 2001 and 2012, 15 patients were admitted for a pancreaticoduodenal injury. All patients experienced blunt trauma, 6 of whom were involved in traffic accidents and 9 of whom received injuries from physical assault. Most of the patients were men(13 of 15 patients, 86%) with a mean age of 23 years (range, 5?39 years). All patients were admitted to the emergency center and managed by the surgeons on duty. The mean value of the injury severity score was 22. The mortality rate was 6%(1 of 15 patients). Seven of the fourteen surviving patients(50%) had duodenal injury, 6 patients(42%) had a pancreatic injury, and 1 patient(7%) had a combined pancreaticoduodenal injury. The surgical procedures were targeted at damage control. Conclusion: In conclusion, we believe that damage control surgery is the optimal management for a pancreaticoduodenal injury.

• Journal of Trauma and Injury
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• v.24 no.2
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• pp.68-74
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• 2011

Purpose: Although pancreas injury is rare in abdominal trauma, it poses a challenge to the surgeon because its clinical features are not prominent and the presence of main duct injury cannot be easily identified by imaging studies. Furthermore, severe pancreas injuries require a distal pancreatectomy or a pancreaticoduodnectomy which are associated considerable morbidity and mortality. We reviewed the clinical features of and outcomes for patients with pancreas injury. Methods: For 10 years from Jan. 2001 to Dec. 2010, thirty-four patients were diagnosed as having pancreas injury by using an explo-laparotomy. Patients successfully treated by non-operative management were excluded. Patients were divided into early (n=18) and delayed surgery groups (n=11) based on an interval of 24hours between injury and surgery. The clinical features of and the outcomes for the patients in both groups were compared. Results: Males were more commonly injured (82.4% vs.17.6%). The mean age was 37.2 years. The injury mechanisms included vehicle accidents (62.9%, 22/34), assaults (20%, 7/34), and falls (11.4%, 3/34). The head and neck of the pancreas was most commonly injured, followed by the body and the tail (16, 12, and 6 cases).Of the 34 patients, 26 (76.5%) patients had accompanying injuries. Grade 1 and 2 occurred in 14 (5 and 9) patients, and grade 3, 4, and 5 occurred in 20 (16, 3, and 1) patients. The early and delayed surgery groups showed no difference in surgical outcomes. Two patients with grade 3 in the early surgery group died after surgery,one due to massive hemorrhage and the other due to septic shock. Of the five patients initially managed non-operatively, three developed peripancreatic necrosis and two developed pseudocyst. All five patients were successfully cured by surgery. Conclusion: All cases of pancreas injury in this study involved blunt injury, and accompanying injury to major vessels or the bowel was the major cause of mortality. Surgery delayed for longer than 24 hours after was not associated with adverse outcomes.

• Journal of Chest Surgery
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• v.27 no.8
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• pp.643-649
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• 1994

We evaluated sixteen patients of traumatic diaphragmatic injuries that we have experienced from Jan. 1987 to Aug 1993. Age was ranged from 6 to 71 years, predominantly in the fourth and fifth decades. 13 were male and 3 were female, a ratio of 4.3: 1. Blunt trauma was develped in 11 [Lt 7, Rt 4], penetrating trauma in 5 [Lt 2, Rt 3]. Preoperative diagnosis of diaphragmatic injury was possible in 8 patients [72.2 %] in blunt trauma, and 1 patient [20 %] in penetrating trauma. 8 cases[54.5%] in blunt trauma, and 4 cases in penetrating trauma were treated within 24 hours,meanwhile, patients treated after 10 days were 3, all by blunt trauma.The repair of 16 cases were performed with thoracic approach in 4 cases, thoracoabdominal approach in 3 cases, and abdominal approach in 9 cases. The herniated organs in thorax were stomach [5], colon [3], liver [2], and pancreas [1]. Postoperative complication were developed in 9cases[56.3%] significantly related with delayed operation time [p < 0.01 ]. Hospital mortality was 12.5 % [2/16], and the causes of death were hypovolemic shock in one and hepatic failure due to portal vein rupture in another.

• Journal of Gastric Cancer
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• v.18 no.2
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• pp.134-141
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• 2018

Purpose: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. Materials and Methods: Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. Results: Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. Conclusions: Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.