Successful combination strategy of preoperative placement of an endoscopic nasopancreatic drainage catheter and pancreas preservation surgery for pancreatic injury with major pancreatic duct disruption: a case report

Kenji Kandori,Wataru Ishii,Ryoji Iizuka

doi:10.1186/s40792-019-0743-1

Kenji Kandori, Wataru Ishii + Show 1 more

Open Access

https://doi.org/10.1186/s40792-019-0743-1

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Abstract

BackgroundThe guidelines recommend pancreatic resection for grade III and IV pancreatic injuries. On the other hand, organ preservation is an important issue. Herein, we present the first case of pancreatic injury with major pancreatic duct (MPD) disruption that was treated with the combination of preoperative placement of endoscopic nasopancreatic drainage (ENPD) catheter and pancreas preservation surgery after endoscopic pancreatic stenting (EPS) failure.Case presentationA 70-year-old female diagnosed with pancreatic injury was admitted to our hospital. She was hemodynamically stable. ERP revealed MPD disruption, and EPS failed. An ENPD catheter was placed preoperatively at the site of injury. During laparotomy, we identified a partial-thickness laceration in the pancreatic body. At the site of injury, the tip of the ENPD catheter was found; therefore, the patient was diagnosed with grade III pancreatic body injury with MPD disruption. The extent of crush was not severe, and we had no difficulty in identifying the distal MPD segment. We inserted the ENPD catheter into the distal MPD segment. The ruptured MPD and the laceration was sutured, then pancreatic resection was prevented. She was discharged on POD 56.ConclusionThe treatment strategy incorporated ERP, placement of an ENPD catheter preoperatively, and a simple surgery in a hemodynamically stable patient with pancreatic injury allows the pancreas and spleen to be preserved.

Highlights

Pancreatic trauma is a rare type of injury, which accounts for 0.2–0.3% of all traumas [1], and it is characterized by high morbidity and mortality
By contrast, based on the data obtained from a systematic review, early endoscopic retrograde pancreatography (ERP) and ductal stenting may treat the injured duct in some cases, even for grade III injuries; thereby, performing major laparotomy and resection is prevented [4]
First of all, when endoscopic pancreatic stenting (EPS) fails, preoperative placement of an endoscopic nasopancreatic drainage (ENPD) catheter helps in the definitive surgery of pancreatic injury with major pancreatic duct (MPD) disruption, and such procedure enables simpler surgery and pancreas preservation

Summary

Conclusion

ERP and preoperative placement of an ENPD catheter should be well considered in the treatment of pancreatic injury in hemodynamically stable patients.

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