Diagnosis and management of pancreatic trauma:a retrospective analysis of 48 cases / 解放军医学杂志

ABSTRACT

Objective To summarize the experiences on the diagnosis of pancreatic trauma and to explore the strategy of its management.Methods The clinical data of 48 patients with pancreatic trauma,who were admitted and treated in the Center for General Surgery,General Hospital of Chengdu Command of PLA from June 1998 to June 2008,were retrospectively studied,and the diagnosis,surgical management,and the therapeutic effects were analyzed.Results Of the 48 patients,32 patients(66.7%) were diagnosed as pancreatic injury before operation,and in 16(33.3%) the final diagnosis was confirmed intraoperatively.For these 48 patients,the degree of pancreatic injury was graded according to AAST-OIS as followsGrade Ⅰ 9 cases,Grade Ⅱ 28 cases,Grade Ⅲ 5 cases,Grade Ⅳ 4 cases and Grade Ⅴ 2 cases.Of the 48 patients,44(91.7%) recovered and 4(8.3%) died.Early complications occurred in 2 cases(4.2%),one with traumatic pancreatitis and another subphrenic Abscess.Late complication such as pancreatic secretion insufficiency occurred in 3 patients(6.3%) in whom resection of distal portion of pancreas was done.7 patients(14.6%) had postoperative complications,including 2 cases of pancreatic pseudocyst,4 cases of pancreatic fistula and 1 case of pancreatic fistula combined with intestinal fistula.Conclusions The early diagnosis of pancreatic trauma should be based on a comprehensive patient history and scrupulous physical examination,aided by auxiliary examinations including serum amylase level,ultrasound,CT scanning,endoscopic retrograde cholangio-pancreatography(ERCP) or magnetic resonance cholangio-pancreatography(MRCP),and laparotomy if necessary.Pancreatic fistula is the main complication following pancreatic trauma and often occurs in the patients with severe pancreatic injury.Aggressive operation on the pancreas is not recommended,while correct judgement of injury to the main duct,a good debridement,effective drainage and flawless pancreaticoenterostomy are the key factors to avoid postoperative fistula.