Original Paper

Pancreatic Transection from Blunt Abdominal Trauma: Early versus Delayed Diagnosis and Surgical Management
Attila Oláh, Ákos Issekutz, László Haulik, Roland Makay

Department of Surgery, Petz Aladár Teaching Hospital, Gyr, Hungary

Address of Corresponding Author

Dig Surg 2003;20:408-414 (DOI: 10.1159/000072708)

  Key Words

• Pancreatic rupture
• Distal transection
• Ductal injury

  Abstract

Background and Aims: Pancreatic trauma is relatively uncommon, but carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Patient Material: The clinical course and surgical management of 14 patients with distal pancreatic transection or severe laceration with or without main pancreatic duct (MPD) injury caused by blunt abdominal trauma were analyzed in a university teaching hospital. The average age of the 14 patients (12 male, 2 female) was 28.9 years (range 5-56). Six patients had isolated pancreatic trauma, and intra-abdominal and extra-abdominal (mean 0.8) injuries associated with pancreatic transection were seen in the other 8 patients. Results: Nine patients were diagnosed and operated on within the first 24 h. Eight of them underwent transection of the gland with MPD injury; distal pancreatectomy with splenectomy was performed in 3 and without splenectomy in 2, distal pancreatogastrostomy in 1, and - due to associated duodenal laceration and/or contusion of the pancreatic head - pylorus-preserving pancreatoduodenectomy in 2. In 1 case (grade II laceration) only external drainage was necessary. All the patients with early, correctly diagnosed parenchymal and ductal injury survived. Only 1 patient required reoperation due to haemorrhage after pancreatoduodenectomy. The other 5 cases were referred elsewhere after initial treatment, and all of them underwent some kind of external drainage. Three had undetected MPD injury, and in the other 2 cases the parenchymal lesions were either underestimated or missed. All of these cases required subsequent resection (1), internal drainage due to fistula (2), or drainage of developed abscess (2). Three of them had severe septic and pulmonary complications; 1 patient with MPD injury was lost to follow-up. Conclusion: Patients requiring delayed surgical intervention after an unsuccessful period of observation or a subsequent operation due to undected MPD injury demonstrated a higher rate of pancreas-specific mortality and morbidity.

Copyright © 2003 S. Karger AG, Basel

  Author Contacts

Attila Oláh, MD, PhD
Department of Surgery, Petz Aladár Teaching Hospital
Vasvári u. 2
HU-9002 Gyr (Hungary)
Tel. +36 96 507936, Fax +36 96 317621, E-Mail olah.seb@arrabonet.gyor.hu

  Article Information

Received: October 29, 2001
Accepted: August 12, 2002
Published online: July 31, 2003
Number of Print Pages : 7
Number of Figures : 4, Number of Tables : 3, Number of References : 11