Diagnosis And Management Of Blunt Pancreatic Trauma: An Analysis Of 12 Cases

Objective: To improve the diagnosis and management of blunt pancreatic trauma, and to propose the strategy of individualization.Methods: 12 cases of blunt pancreatic trauma were reviewed and analyzed retrospectively,which were from Union hospital affiliated to Fujian Medical University between August 2000 and May 2008. The 12 patients included 10 male and 2 male patients. There are 7 children and 5 adults. All pancreatic injuries were due to blunt upper abdominal trauma. Handlebar injuries lead to pancreatic trauma in all of the seven children. Contrast-Enhanced CT was done in all patients and pancreatic injury was correctly predicted by CT in all of them. There were 0 grade I,1 grade II,4 grade III,7 grade IV and 0 grade V injuries, according to AAST classification system.Results: All patients were cured. 1 of 4 patients of pancreatic head injury successfully completed the nonoperative course, and delayed operation was performed in the other 3 patients, included pancreaticoduodenectomy in 1, Roux-en-Y pancreatic cyst-jejunostomy in 1 and cyst-gastrostomy in 1. 1 of 4 patients of pancreatic neck injury underwent delayed operation of external drainage of pseudocyst, 3 patients required immediate operation, included drainage alone in 1, external drainage of the injured pancreatic duct in 2, whom underwent definitive operation six months later. Among the 4 patients with injury to pancreatic body and tail ,2 patients recieved pre-hospital immediate operation of laparotomy and drainage, and developed traumatic pancreatitis, which was cured by pancreatic debridement,1 patient underwent pre-hospital distal pancreatectomy and splenectomy, and developed pancreatic fistula, which was cured by conservative management, delayed operation of Roux-en-Y pancreatic cyst-jejunostomy was performed in 1 patient.Conclusion: The strategy of individualization can be applied in the management of pancreatic trauma. The integrity of the main pancreatic duct is the most important determinant. In the absence of major pancreatic ductal injury or clinical deterioration, pancreatic injuries can be treated with nonoperative management initially and delayed operation can be performed for the pancreas specific complication. Damage control surgery plays an important role in the management of pancreatic trauma.