Management and outcome of pancreatic trauma: a 6-year experience at a level I trauma center

A. Anand, P. Dar, Preksha Rani, Supreet Kaur, J. James, J. Alam, Pratyusha Priyadarshini, Abhinav Kumar, D. Bagaria, Narendra Choudhary, Subodh Kumar, Amit Gupta, S. Sagar, Biplab Mishra
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Abstract

Abstract Background Pancreatic trauma (PT) accounts for less than 1% of all trauma admissions. Occasionally, PT is undetected during the primary survey and becomes apparent only when complications arise. It occurs in up to 5% of blunt abdominal trauma cases and 12% of individuals with penetrating abdominal injuries. Management is determined by the status of the main pancreatic duct and associated injuries. Methods This was an ambispective study conducted at the Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, from January 2015 to December 2017 (retrospective), and January 2019 to December 2020 (prospective). In total, 113 patients with PT were included in this study. Results We analyzed the data of 113 patients with PT included in this study, of which males predominated (93.7%). Blunt PT was present in 101 patients (89.4%) and penetrating PT in 12 patients (10.6%). Half of the patients (51.3%) had the American Association for the Surgery of Trauma grade III PT, followed by grade II (18.6%), and grade I (15%). Of the total 113 patients, 68 (60.2%) were treated with operative management, and 45 (39.8%) with nonoperative management. Distal pancreatectomy, with or without splenectomy, was the most common procedure performed in our study, followed by drainage. There were 27 mortalities (23.8%) during the study period, of which 7 were directly related to PT and 20 were due to other organ-related sepsis and hemorrhagic shock. Conclusion Pancreatic trauma is rare but challenging for trauma surgeons, with persistent management controversies. Early diagnosis is important for favorable results; however, a delay in diagnosis has been associated with higher morbidity and mortality. Low-grade pancreatic injuries can be successfully managed nonoperatively, whereas high-grade pancreatic injuries require surgical intervention.
胰腺创伤的处理和结果:一级创伤中心6年的经验
摘要背景胰腺创伤(PT)占所有创伤入院人数的不到1%。有时,PT在初次调查中未被发现,只有在出现并发症时才变得明显。它发生在高达5%的钝性腹部创伤病例和12%的穿透性腹部损伤患者中。治疗由主胰管的状况和相关损伤决定。方法这是一项在新德里全印度医学科学研究所Jai Prakash Narayan Apex创伤中心进行的前瞻性研究,时间分别为2015年1月至2017年12月(回顾性)和2019年1月和2020年12月。本研究共纳入113例PT患者。结果我们分析了113例PT患者的数据,其中男性占主导地位(93.7%)。钝性PT有101例(89.4%),穿透性PT有12例(10.6%)。其中一半(51.3%)的患者具有美国创伤外科协会III级PT,其次是II级PT(18.6%)和I级PT(15%)。在总共113名患者中,68名(60.2%)接受了手术治疗,45名(39.8%)接受了非手术治疗。在我们的研究中,胰远端切除术,包括或不包括脾切除术,是最常见的手术,其次是引流。研究期间共有27例死亡(23.8%),其中7例与PT直接相关,20例死于其他器官相关的败血症和失血性休克。结论胰腺创伤是罕见的,但对创伤外科医生来说是具有挑战性的,其管理一直存在争议。早期诊断对取得良好结果很重要;然而,诊断的延迟与更高的发病率和死亡率有关。低级别胰腺损伤可以通过非手术成功治疗,而高级别胰腺损伤需要手术干预。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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