Abstract
Blunt trauma injuries to the pancreas are rare but are associated with significant overall mortality and a high complication rate. Motor vehicle collisions are the leading cause of blunt pancreatic trauma, followed by falls, and sports injuries. We discuss the decision-making process used during the clinical courses of 3 patients with life-threatening blunt pancreatic injuries caused by traumatic falls. We also discuss the utility of the American Association for the Surgery of Trauma Organ Injury Scale (AAST-OIS), which provides a system for grading pancreatic trauma. Retrospectively, the cases reviewed were classified as AAST-OIS grade II, III, and IV in each one patient. Although the nonoperative approach was initially preferred, surgery was required in each case due to pseudocyst formation, pancreatic necrosis, and posttraumatic pancreatitis. In each case, complete healing was achieved through exploratory laparotomy with extensive lavage and placement of abdominal drains for several weeks postoperatively. These cases show that nonoperative management of pancreatic ductal trauma results in poor outcomes when initial therapy is less than optimal.
Highlights
Background and Case Series PresentationBlunt pancreatic injuries are usually the result of a substantial force to the upper abdomen that results in compression of the pancreas against the lumbar vertebrae [1]
Frequent complications after blunt pancreatic trauma include fistula and pseudocyst formation, traumatic pancreatitis and pancreatic abscesses, and less frequent complications such as peritonitis, gastrointestinal bleeding, and splenic vein thrombosis [2, 7]. e most widely accepted classification and grading system for pancreatic trauma is the Organ Injury Scale (OIS) developed by the American Association for the Surgery of Trauma (AAST) [8]. e main determinants of the score using this scale are the location of the injury and the presence of damage to the pancreatic parenchyma and the ductal system (Table 1)
Falls from various heights were responsible for pancreatic injury in each of the cases in this series. e diagnoses were made using a combination of clinical observations, laboratory markers, ultrasonography, and Computed tomography ISS (CT) imaging
Summary
Blunt pancreatic injuries are usually the result of a substantial force to the upper abdomen that results in compression of the pancreas against the lumbar vertebrae [1]. Half of pancreatic lesions occur in the setting of multiple injuries caused by a major trauma. Pancreatic injuries account for less than 2% of blunt abdominal trauma injuries [3, 4]. E most widely accepted classification and grading system for pancreatic trauma is the Organ Injury Scale (OIS) developed by the American Association for the Surgery of Trauma (AAST) [8]. We retrospectively report the diagnoses, management, and subsequent clinical courses of three patients with lifethreatening blunt pancreatic injuries caused by traumatic falls. All these patients received emergency whole-body CT at presentation. Complete healing was achieved through exploratory laparotomy with extensive lavage and the placement of abdominal drains for several weeks postoperatively
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