Traumatic Pancreatic Injury Presentation, Management, and Outcome: An Observational Retrospective Study From a Level 1 Trauma Center.

Hassan Al-Thani,Ayman El-Menyar,Gustav Strandvik,Ahmed Faidh Ramzee,Ammar Al-Hassani

doi:10.3389/fsurg.2021.771121

Hassan Al-Thani, Ayman El-Menyar + Show 3 more

Open Access

https://doi.org/10.3389/fsurg.2021.771121

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Abstract

BackgroundWe aimed to study the presentation, management, and outcomes of patients with a pancreatic traumatic injury.MethodsWe retrospectively analyzed data for all patients who were admitted with pancreatic injuries between 2011 and 2017 at the only level 1 trauma center in the country.ResultsThere were 71 patients admitted with pancreatic trauma (0.6% of trauma admissions and 3.4% of abdominal injury admissions) with a mean age of 31 years. Sixty-two patients had pancreatic injury grade I–II and nine had injury grade III–IV. Thirty-eight percent had Glasgow Coma Scale (GCS) <9 and 73% had injury Severity Score (ISS) >16. The level of pancreatic enzymes was significantly proportional to the grade of injury. Over half of patients required laparotomy, of them 12 patients had an intervention on the pancreas. Eight patients developed complications related to pancreatic injuries ranging from pancreatitis to pancreatico-cutaneous fistula while 35% developed hemorrhagic shock. Mortality was 31% and regardless of the grade of injury, the mortality was associated with high ISS, low GCS, and presence of hemorrhagic shock.ConclusionPancreatic injuries following blunt trauma are rare, and the injured subjects are usually young men. However, most injuries are of low-grade severity. This study shows that regardless of the pancreatic injury grade on-admission shock, higher ISS and lower GCS are associated with worse in-hospital outcomes. Non-operative management (NOM) may suffice in patients with lower grade injuries, which may not be the case in patients with higher grade injuries unless carefully selected.

Highlights

Pancreatic injury following abdominal trauma is a rare entity, it is usually associated with other visceral injuries and entails significant morbidity and mortality
Our routine trauma investigations include plain chest and pelvic x-ray followed by pan-CT scan and later on, we may consider follow-up CT scan and or magnetic resonance cholangiopancreatography (MRCP) depending on the clinical evaluation and complexity of the injury, we may consider endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool, if indicated
Motor vehicle collisions were the most common mechanism of injury followed by fall from height

Summary

Introduction

Pancreatic injury following abdominal trauma is a rare entity, it is usually associated with other visceral injuries and entails significant morbidity and mortality. The morbidity and mortality rates vary as 23.4–53% and 17.5–70%, respectively [1,2,3]. A high index of suspicion is necessary as the retroperitoneal location of the pancreas contributes to a delay in the presentation of signs, symptoms, and biochemical changes in the initial stages of injury [3, 5]. The incidence of pancreatic injury has been reported in 0.4–3.6% of all trauma admissions and 3.7–11% in patients with abdominal trauma [1, 6,7,8,9,10]. We aimed to study the presentation, management, and outcomes of patients with a pancreatic traumatic injury

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