Diagnosis and treatment of blunt pancreatic injury / 中国普通外科杂志

Objective To study the diagnosis and treatment of blunt pancreatic injury (BPI). Methods A retrospective analysis was made on the clinical data of 58 cases of BPI admitted and treated in our hospital during 23 years. Results The positive diagnosis rate was 51.1%(23/45) for single BUS examination ,but 70.0%(21/30) for two and more BUS examimations. The positive diagnosis rate was 65.0%(26/40) for single CT scanning, but 91.3%(21/23) for two and more CT scannings. Twenty-five cases(25/37,67.6%) with BPI were determined preoperatively, and 12 cases(12/37,32.4%)during (operation).Thirty-seven cases underwent operatiom, included grade I in 10cases、grade II 13cases、grade III 9cases、 grade IV 4cases and gradeV 1case. Twenty-one cases received nonoperative treatment, included 11 grade in I,7 grade II and 3 grade III. In the entire group, 6 cases died(10.4%).The mortality in the operation group was 16.2%(6/37).There were no deaths in the nonoperative group. The main cause of death was multiorgan failure(5/6,83.3%). There were 11(19.0%)cases of pancreatic pseudocyst after treatment in the entire group, included 3(3/37,8.1%) in operation group and 8(8/21,38.1%) in nonoperation group. Conclusions The diagnosis of BPI should combine the clinical findings with repeated BUS and CT scanning. Nonoperative treatment is a good choice for BPI without main pancreatic duct injury. Operative treatment is suitable for serious BPI and those with other intra-abdominal organ jnjury.

Diagnosis and treatment of blunt pancreatic injury:a report of 32 cases / 中国普通外科杂志

Objective To explore the methods for early diagnosis and treatment of blunt pancreatic injury.Methods The clinical data of 32 patients with blunt pancreatic injury treated in our hospital from Janurery 2004 to Janurery 2009 were retrospectively analyzed.Results The conformity diagnosis rate of CT was 79.3%.Four cases received nonoperative treatment including 3 cases of grade I and 1 of grade II injury.A total of 28 cases with blunt pancreatic injury underwent operation: 5 grade I and 7 grade II cases underwent debridement and drainage;among the patients with grade Ⅲ injury,4 underwent distal pancreatectomy in combination with splenectomy,and 2 pancreatectomy with spleen preservation;amongst the 5 patients with grade Ⅳ injury,4 underwent Roux-en-Y pancreaticojejunostomy and 1 underwent distal pancreatectomy in combination with splenectomy;of the 5 patients with grade Ⅴ injury,1 case was operated on using duodenorrhaphy and diverticulization,2 underwent the Whipple′s procedare and 2 had damage control surgery.Three patients died of multiple organ failure,and complications occurred in 19(76.0%).Pancreatic fistula and pancreatic pseudocysts were the main complications.Conclusions In the absence of major pancreatic ductal injury,and the clinical conditions were stable,pancreatic injuries can be treated with nonoperative management.Operative treatment is suitable for severe blunt pancreatic injury.Appropriate operation,based on patient condition and the classification of pancrecatic trauma,is the key to increase the cure rate and decrease mortality rate.

Diagnosis and treatment of pancreatic trauma / 中国普通外科杂志

Objective To investigate the diagnosis and management of pancreatic injury. Methods The clinical data of 23 patients suffering from pancreatic injury treated by surgery in recent 15 years were analyzed retrospectively. According to the pancreas organ injury scale of the American Association for the Surgery of Trauma, there were 8 cases in grade I, 8 in grade II, 5 in grade III, 1 in grade IV and 1 in grade V. Results Only 2 patients were diagnosed preoperatively out of the 19 patients.About 63.2%(12/19)of the cases had elevated levels of serum amylase. All the patients were cured.In this series,8 cases occurred external pancreatic fistula, 4 pseudocysts, 2 intra-abdominal infections and 1 hyperglycemia postoperatively. Internal pancreatic fistulas were found in all the non operation patients. Conclusions The serum amylase determinations is neither sensitive nor specific for diagnosis of pancreatic injury. Early diagnosis and correct operative pracedure are important to decrease the postoperative complications and improve the outcome.

Treatment of severe duodenal trauma / 中国普通外科杂志

Objective To study the operative method for severe duodenal trauma.Methods The clinical data of 38 cases of severe duodenal trauma complicated with pancreatic injury who underwent different operations between 1992—2006 year were reviewed.Results In 8 cases duodenal diverticulization was performed,of which 5 cases were cured,2 cases developed intestinal fistula,and one died.Of 9 cases who underwent panceaticoduodenectomy(PD),3 were cured but 6 had pancreatic leakage,and 3 of them died.Of 16 cases who had primary repair of ruptured duodenum with simple suture or patch suture,13 cases cured,2 cases developed intestinal fistula and one patient died.Five patients underwent duodenal repair and excision of head of pancreas plus pancreaticojejunostomy(PD with preserved duodenum),4 cases recovered and 1 had pancreatic leakage,but 3 with wrap-type pancreaticojejunostomy had no complications.Conclusions The repair of ruptured duodenum with simple suture plus duodenostomy and jejunostomy is preferential option for majority of cases of duodenal trauma.This procedure plus removal of head of pancreas and pancreaticojejunostomy(PD with preserved duodenum) can be used for severe pancreatic injury with excellent result,but duodenal diverticulization or panceaticoduodennectomy must not be undertaken lightly.

Diagnosis and treatment of severe pancreatic trauma / 中国普通外科杂志

Objective To evaluate the diagnosis and treatment of severe pancreatic trauma(SPT). Methods The clinical data of 32 patients with transected pancreatic trauma(grade 3-5) admitted into our hospital in recent 20 years were retrospectively analyzed. Results Twenty patients were in grade 3, 10 in grade 4,and 2 in grade 5. Operations were performed on all 32 patients. Twenty-five recovered, and 7 died. The mortality was 21.9%.Before the operation, peritoneal lavage fluid amylase rose in 10 patients(50%),and serum amylase rose in 12 patients(60%). Imaging examination included ultrasonography in 10 (diagnosed in 3),and CT in 8 (diagnosed in 3). Diagnosis was established only in 10 patients before the operation. Complications included fistula, abscess and pseudocyst. Conclusions Incidence of associated trauma is high. The preoperative diagnosis of pancreatic trauma is difficult. The rates of morbidity and mortality are high. Early diagnosis, careful exploration and proper surgery are very important. Intraoperative pancreatography or ultrasonographic scanning is useful in diagnosis. Somatostatin and human growth hormone are useful in the treatment.