Pancreaticoduodenal injuries at a tertiary care centre-clinical profile, associated injuries, management modalities, and outcomes

Abstract

Background: Pancreaticoduodenal injuries are considerably associated with high morbidity and mortality due to delayed diagnosis and subsequent delay in treatment. This makes the treatment of these injuries challenging. We have studied the presentation, diagnosis, management and outcome of these complex injuries. Methods: A prospective observational study was done at general surgery department, Government medical college Nagpur from October 2020 to September 2022. Mortality, morbidity, and various treatment modalities were evaluated. Results: Thirty two patients presented to the Trauma care center with history and symptoms suggestive of isolated pancreatic, duodenal, and combined pancreaticoduodenal injuries. Most of the injuries were blunt trauma cases. The ratio of hemodynamically stable: unstable was 1:1. Majority injuries were to pancreas followed by duodenum and combined organ injuries. Most of cases were diagnosed by CT scan. In this study 56% of cases had a non-operative line of treatment while 44% underwent surgical intervention. Among the patients operated 5 died, within 7 days of admission due to post-operative complications-hemorrhage, sepsis, aspiration pneumonia, and anastomotic leak. Two patients died due to delayed complications due to the development of pancreatic fistula and enterocutaneous fistula. Mortality rate was 27.2% in this study. Conclusions: Early presentation and prompt diagnosis is the key to the management of such injuries. Patients managed conservatively need close monitoring, repeated assessments, and long-term follow-up.