Outcomes of hemodynamically stable patients with pancreatic injury after blunt abdominal trauma

Abstract

BackgroundTo date there is no systematical report about blunt pancreatic injury focused on hemodynamically stable patients. This study reports on our experience in this rare subgroup at a tertiary referral hospital. MethodsA total of 58 adult patients were identified during a 10-year period and their clinical data were analyzed. Injury to the main pancreatic duct (MPD) was basically confirmed by pancreatography or surgical findings. ResultsMPD disruption was confirmed in 36 patients (62%) and was more frequent in the pancreatic neck and body. The median time from trauma to confirmation was 14 days [interquartile range (IQR) 3–23 days] including time from admission to confirmation of 10.5 days [IQR 3–20 days]. Patients with MPD injury showed higher injury severity score, more frequent pancreas-specific complications and longer hospital stays. The sensitivity and specificity of initial computed tomography (CT) for MPD injury were 63.9% (23/36) and 81.8% (18/22), respectively. The mortality rate was 7%, and all deaths were directly attributed to pancreatic injury. Complications occurred in 22 patients (37%) and 17 developed during hospitalization. Time from trauma to confirmation of MPD disruption (odds ratio 1.132; 95% confidence interval 1.021–1.255, P=0.019) was the only independent factor associated with unfavorable events among patients with high-grade injury. ConclusionsMPD injury was not infrequent in hemodynamically stable patients. Physicians were more responsible for the delay in diagnosis of MPD disruption, which was primarily associated with adverse outcomes. A rapid, multidisciplinary approach may lead to better outcomes in hemodynamically stable patients with blunt pancreatic injury.