Dagnosis and treatment of traumatic pancreatic injury

Abstract

Objective To investigate the diagnosis and treatment of traumatic pancreatic injury.Method The clinical data of 35 patients with traumatic pancreatic injury treated between January 1998and July 2010 at the General Hospital of Chinese PLA were retrospectively analyzed.Results There were 9 patients with Grade Ⅰ injury,7 with Grade Ⅱ injury,7 with Grade Ⅲ,7 with Grade Ⅳ,and 5 with Grade V injury,respectively.The diagnostic rate using CT before operation was 75.8％.8 patients with mild traumatic pancreatic injury received nonoperative treatment. 27 patients underwent open operation which included 15 simple external drainage of the pancreas area,2 distal pancreatectomy,5 Roux-en-Y pancraticojejunostomy,3 duodenal diverticulisation procedure,and 2 pancreaticoduodenectomy.After operation,there were 14 patients with pancreatic leakage,9 with intraabdominal infection,and 6 with intrabdominal bleeding.There were 3 patients with Grade Ⅳ and Grade V injuries who died of multiple organ failure or uncontrolled massive intraabdominal bleeding.Conclusions It was difficult to diagnose pancreatic injury before operation.CT was a suitable method to accurately diagnose severe traumatic pancreatic injury.Most minor pancreatic injury could be treated nonoperatively or by external drainage.The appropriate operation should be selected according to the extent and degree of the injuries basing on the principle of damage control in patients with major injuries.Pancreatic fistula,intraabdominal infection and bleeding were conrmon complications after operation.Multiple organ failure and massive bleeding were the main causes for mortality. Key words: Pancreas; Abdominal injuries; Diagnosis; Treatment; Postoperative complications