Clinical update on management of pancreatic trauma

HPB : the Official Journal of the International Hepato Pancreato Biliary Association
Kjetil SøreideRowan W Parks

Abstract

Pancreatic injury is rare and optimal diagnosis and management is still debated. The aim of this study was to review the existing data and consensus on management of pancreatic trauma. Systematic literature review until May 2018. Pancreas injury is reported in 0.2-0.3% of all trauma patients. Severity is scored by the organ injury scale (OIS), with new scores including physiology needing validation. Diagnosis is difficult, clinical signs subtle, and imaging by ultrasound (US) and computed tomography (CT) non-specific with <60% sensitivity for pancreatic duct injury. MRCP and ERCP have superior sensitivity (90-100%) for detecting ductal disruption. Early ERCP with stent is a feasible approach for initial management of all branch-duct and most main-duct injuries. Distal pancreatectomy (±splenectomy) may be required for a transected gland distal to the major vessels. Early peripancreatic fluid collections are common in ductal injuries and one-fifth may develop pseudocysts, of which two-thirds can be managed conservatively. Non-operative management has a high success rate (50-75%), even in high-grade injuries, but associated with morbidity. Mortality is related to associated injuries. Pancreatic injuries are rare and can often be m...Continue Reading

Citations

Mar 6, 2019·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·A Leppäniemi
Dec 24, 2019·World Journal of Emergency Surgery : WJES·Federico CoccoliniUNKNOWN WSES-AAST Expert Panel
May 31, 2019·Scandinavian Journal of Surgery : SJS : Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society·C M KuzaJ E Scarborough
Nov 28, 2020·Radiographics : a Review Publication of the Radiological Society of North America, Inc·Andres R AyoobTarek N Hanna
Jan 21, 2021·Journal of Clinical Medicine·Madeline DrakeTien C Ko
Jul 21, 2021·La Radiologia medica·Francesca IacobellisLuigia Romano

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