BLUNT INJURY OF PANCREAS, GALL BLADDER AND EXTRAHEPATIC BILE DUCTS: TACTICS BASED ON THE PRINCIPLES OF EVIDENCE-BASED MEDICINE

Abstract

Objective. Optimization of treatment and diagnostic tactics for blunt injury of the pancreas, gall bladder and extrahepatic bile ducts. Methods. This current review was undertaken by Russian and foreign literature (2015-2020 yrs) search according to the following themes: pancreatic injury, traumatic pancreatitis, gall bladder injury, extrahepatic bile ducts injury, damage control surgery tactics, blunt abdominal trauma, therapeutic and diagnostic algorithm, conservative (non-operative) management, with subsequent exception from the request of experimental studies and cases of open trauma in the Internation scientific datebase PubMed, Cochrane Library, Scopus, Embase, ScienceDirect, Google Scholar Search, eLibrary. Multicenter studies, systematic reviews, meta-analyses, large case series, original articles, and randomized controlled trials were analyzed, indicating the levels of evidence and effectiveness of recommendations. An original algorithmfor thediagnosis and management is proposed, the concept of damage control is described, and indications for diagnostic methods, conservative treatment, and types of surgical, endovascular, and minimally invasive interventions are specified depending on the severity of organ injury according to the classification of the American Association of the Surgery of Trauma (AAST) (table). Results. The algorithmfor thediagnosis and management for combined blunt trauma of the pancreas, gallbladder, and extrahepatic bile ducts is standardized, and indications for minimally invasive and open interventions in this category of patients are clarified. Conclusion. Accurate knowledge of the algorithm for the diagnosis and management, indications for endovascular, minimally invasive techniques and open interventions, the choice of tactics based on the patient’s condition, the time of the injury, and possible complications can improve the results of treatment.