Reconstruction After Pancreatic Trauma By Pancreatogastrostomy

Abstract

Introduction: Pancreatic trauma are very infrequent after closed abdominal trauma.(5%) with a morbidity rate of 30-40% and mortality rate of 40%.In our experience of closed abdominal trauma sustained following road traffic accident, injury to the pancreas constitues high risk of pancreatic injury. The purpose of my presentation is to raise awareness about our experiance in the diagnosis and treatment of pancreatic injury secondary to blunt abdominal trauma. Method: We present a clinical cases of 2 young patients who were diagnosed with type 3 pancreatic injury sustained while falling down from a bicycle and bike respectively.The treatment was surgical in both the cases and we had performed the reconstruction by pancreatogastrostomy with preservation of the distal pancreas and spleen.Post operative period was unremarkable and both the patients are asymptomatic. Result: Signs and symptoms caused by pancreatic trauma are non specific and is difficult to objectify.With some limitations, CT Abdomen is the imaging test of choice for diagnosis and staging in acute phase.The injury to the pancreatic duct with complete transaction is the indication for surgical treatment.The most common surgical technique is the distal pancreatectomy and splenectomy.However. we have performed the pancreatogastrostomy reconstruction to the distal pancreas with preservation of the pancreas and spleen as well.Postoperative period was unremarkable except in one patient who had developed a pancreatic fistula(Type 1- ISGPF) which resolved spontaneously and both the patients are doing well at one year follow up. Conclusion: The indication of pancreatic injury after closed abdominal trauma requires a high degree of suspicion based on the injury mechanism. A safer option may be the distal pancreatic preservation with pancreatogastrostomy in grade III pancreatic injury with healthy pancreatic tissue.