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Hepatobiliary Surg Nutr · Dec 2016
Conservative and surgical management of pancreatic trauma in adult patients.
- Benjamin Menahem, Chetana Lim, Eylon Lahat, Chady Salloum, Michael Osseis, Laurence Lacaze, Philippe Compagnon, Gerard Pascal, and Daniel Azoulay.
- Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
- Hepatobiliary Surg Nutr. 2016 Dec 1; 5 (6): 470-477.
BackgroundThe management of pancreatic trauma is complex. The aim of this study was to report our experience in the management of pancreatic trauma.MethodsAll patients hospitalized between 2005 and 2013 for pancreatic trauma were included. Traumatic injuries of the pancreas were classified according to the American Association for Surgery of Trauma (AAST) in five grades. Mortality and morbidity were analyzed.ResultsA total of 30 patients were analyzed (mean age: 38±17 years). Nineteen (63%) patients had a blunt trauma and 12 (40%) had pancreatic injury ≥ grade 3. Fifteen patients underwent exploratory laparotomy and the other 15 patients had nonoperative management (NOM). Four (13%) patients had a partial pancreatectomy [distal pancreatectomy (n=3) and pancreaticoduodenectomy (n=1)]. Overall, in hospital mortality was 20% (n=6). Postoperative mortality was 27% (n=4/15). Mortality of NOM group was 13% (n=2/15) in both cases death was due to severe head injury. Among the patients who underwent NOM, three patients had injury ≥ grade 3, one patient had a stent placement in the pancreatic duct and two patients underwent endoscopic drainage of a pancreatic pseudocyst.ConclusionsOperative management of pancreatic trauma leads to a higher mortality. This must not be necessarily related to the pancreas injury alone but also to the associated injuries including liver, spleen and vascular trauma which may cause impaired outcome more than pancreas injury.
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