Magnitude, Severity, and Outcome of Traumatic Pancreatic Injury at a Level I Trauma Center in India.

Abstract

Pancreatic injury is an uncommon and frequently missed injury in abdominal trauma patients. However, missed pancreatic injury is associated with significant morbidity and mortality. This study was conducted to know the burden of pancreatic injury and its outcome in our setup. A retrospective analysis of 53 patients with pancreatic injury from January 2008 through March 2012 at the Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi. Pancreatic injuries were present in 1.18% of all trauma admissions. Blunt trauma to the abdomen (n = 49, 92.45%) due to road traffic injury (n = 38, 71.70%) was the most common mechanism of injury. Isolated pancreatic injury was present in eight (15.09%) patients. Grade III pancreatic injury (n = 25, 47%) was the most common. Of these patients, 18.86% were managed nonoperatively and 81.13% were managed operatively. Among the operatively managed patients (n = 43), 74.4% were operated due to pancreatic injury and 25.5% were operated due to associated injuries. Distal pancreatectomy with or without spleen preservation (n = 25) was the most common operative procedure done. Three out of five patients of Whipple operation for pancreatic injury died. Pancreatic injury was associated with complications in 43.40% and death in 20% (n = 11). Pancreatic injury is rare, but delay in diagnosis of pancreatic injury has been associated with higher morbidity and mortality. Low-grade pancreatic injury with intact main pancreatic duct (MPD) could be successfully managed nonoperatively, whereas in high-grade pancreatic injury, an operative intervention is invariably necessary. Distal pancreatectomy with spleen preservation is a desirable goal whenever possible for distal transaction of the pancreas. Whipple resection should be reserved only for hemodynamically stable patients with complex pancreaticoduodenal injury and is associated with high mortality.