Management of Pancreatic Injuries after Blunt Abdominal Trauma

Published in Journal of the Pancreas on 5 November 2009

K.K. Tan, D.X. Chan, A. Vijayan, M.T. Chiu
TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore

Abstract

Context

Pancreatic injuries after blunt abdominal trauma could result in significant morbidity, and even mortality if missed.

Objective

Our aim was to review our institution’s experience with blunt pancreatic trauma.

Setting

Our study included all cases of blunt traumatic pancreatic injuries.

Patients

Sixteen patients (median age 41 years; range: 18-60 years) were treated for blunt pancreatic trauma from December 2002 to June 2008.

Main Outcome Measure

Pancreatic injuries were graded according to the definition of the American Association for the Surgery of Trauma (AAST).

Results

CT scans were performed on 10 (62.5%) patients, with the remaining 6 (37.5%) sent to the operating theatre immediately due to their injuries. Of the 12 (75.0%) patients who underwent exploratory laparotomy, 2 (12.5%) had a distal pancreatectomy (AAST grade III), 1 (6.3%) underwent a Whipple procedure (AAST grade IV) while another 2 (12.5%) were too hemodynamically unstable for any definitive surgery (AAST grade IV and V); the remaining 7 (43.8%) pancreatic injuries were managed conservatively. Four (25.0%) patients had their injuries managed non-operatively. Some of the associated complications included intra-abdominal collection (n=2, 12.5%) and chest infection (n=2, 12.5%).

Conclusion

Blunt pancreatic trauma continues to pose significant diagnostic and therapeutic challenges. In view of the numerous associated injuries, priority must be given to stabilizing the patient before any definitive management of thepancreatic injuries is carried out. Mortality in these patients is usually a result of the magnitude of their associated injuries.