Abstract
BackgroundA high-grade pancreatic injury is a life-threatening injury that is associated with high mortality and morbidity. It is currently unclear which treatment strategy results in good clinical outcomes.Case presentationA 23-year-old Japanese woman sustained severe injury in a motor vehicle accident. Abdominal computed tomography revealed severe pancreatic head injury with extravasation of contrast media. Since it was not possible to insert an endoscopic pancreatic stenting tube into the main pancreatic duct, damage control surgery was performed. On day 3, we could insert the endoscopic pancreatic stenting tube from the ampulla of Vater and an endoscopic nasopancreatic drainage tube in the distal pancreatic duct from the accessory ampulla before the second operation. Drainage tubes were placed around the pancreatic head in the second operation. The endoscopic nasopancreatic drainage tube tube was converted to endoscopic pancreatic stenting tube on day 9. On day 51, the patient was discharged on foot from our hospital without serious complications.ConclusionEarly and effective hemostasis, staged pancreatic duct drainage with stenting, and surgical external drainage around the pancreas in combination with an endoscopic procedure and damage control surgery were considered appropriate therapeutic strategy for high-grade pancreatic injury.
Highlights
A high-grade pancreatic injury is a life-threatening injury that is associated with high mortality and morbidity
magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) have been shown to be effective as diagnostic tools for pancreatic duct injury; their application is limited based on reviews of case series [3]
Since treatment failure following nonoperative management occurs with a fixed probability and a delay in surgical treatment leads to serious clinical outcomes, pancreatic resection and subsequent reconstructions have been performed in these high-grade pancreatic injuries [4]
Summary
The multimodal treatments combining endoscopic therapy and DCS, including early and appropriate hemostasis, staged pancreatic duct drainage with stenting, and surgical external drainage around the pancreas instead of pancreatic resection and complex reconstruction were considered feasible therapeutic strategy to pancreatic injury of AAST grade IV.
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