Intraoperative ultrasound to assess for pancreatic duct injuries

Abstract

Abstract : While pancreatic injuries are relatively uncommon, the morbidity and mortality associated with such injuries are high. Of all pancreatic injuries, most result from penetrating rather than blunt trauma. It is estimated that 6% of abdominal gunshot wounds and 2% of abdominal stab wounds result in a pancreatic injury. The mortality associated with pancreatic injuries ranges from 20% to 45%, while the pancreas-specific complication rate is higher than 35%. Involvement of the pancreatic duct is the main determinant of morbidity and mortality from a pancreatic injury. Not surprisingly, a delay in diagnosis of a main pancreatic ductal injury over 6 hours to 12 hours further contributes to the high complication and death rate of pancreatic injuries. Furthermore, diagnosis of pancreatic ductal involvement requires operative resection rather than placement of drains or nonoperative management. However, determining whether the pancreatic duct is involved in the injury remains one of the greatest challenges in trauma surgery. Diagnosing pancreatic ductal injuries often requires a multimodal imaging approach by a multidisciplinary team. Un- fortunately, intraoperative cholecystocholangiopancreatography is often nondiagnostic, gastroenterologists may not be available for endoscopic retrograde cholangiopancreatography (ERCP), and the patient may be excluded from magnetic resonance cholangiopancreatography (MRCP) because of skeletal traction equipment or previous metal implants. Surgeon-controlled intra-operative pancreatic ultrasound (US) may overcome these limitations. In this article, we describe our use of interoperative US as an adjunct to evaluate for ductal involvement in pancreatic injuries.