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Naiem MEA, Arabi NA. Isolated pancreatic injury in an adolescent treated with Roux-en-Y pancreatojejunostomy: a case report and review of the literature. J Med Case Rep 2021; 15:474. [PMID: 34526117 PMCID: PMC8444418 DOI: 10.1186/s13256-021-03042-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/02/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Pancreatic injury presented as isolated injury in the pediatric population is exceptionally rare, with a conveyed incidence of less than 2% of all abdominal trauma injuries cases and a very controversial management approach for grade III injuries. CASE PRESENTATION A 16-year-old adolescent Sudanese boy was referred to our emergency department with a 5-day history of upper and left hypochondrial pain after blunt abdominal trauma to the epigastric region with a solid object. Grade III pancreatic body trauma with major duct involvement can be successfully treated operatively. The boy was discharged home on day 10 with regular oral intake and diet. A follow-up for 6 months continued by phone, and it was uneventful with no further complications. CONCLUSIONS Roux-en-Y pancreatojejunostomy reconstruction can be a safe and valuable surgical option when the surgical approach is considered for grade III pancreatic injury.
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Affiliation(s)
| | - Nassir Alhaboob Arabi
- Department of Gastrointestinal and Hepato-Pancreatic-Biliary Surgery, Ibn Sina Specialized Hospital, Khartoum, Sudan
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Carrascosa-Mirón T, Carabias Hernández A, Rodríguez-Padilla J, Manuel-Vázquez A, Jover-Navalón JM. Lesión pancreática aislada tras traumatismo abdominal cerrado: a propósito de un caso. REVISTA COLOMBIANA DE CIRUGÍA 2021. [DOI: 10.30944/20117582.564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La incidencia de lesiones traumáticas del páncreas es baja debido a su localización retroperitoneal, y las lesiones aisladas son excepcionales debido a la proximidad del páncreas a otros órganos y estructuras vasculares.
Caso clínico. Presentamos el caso de un varón de 21 años con lesión aislada del páncreas tras traumatismo abdominal cerrado, que precisó manejo quirúrgico.
Discusión. Las lesiones pancreáticas aisladas secundarias a traumatismo son raras, pero debemos tenerlas en cuenta en un paciente politraumatizado. Su diagnóstico precoz y manejo adecuado son cruciales para evitar el desarrollo de complicaciones.
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Ravindranath A, Srivastava A, Yachha SK, Poddar U, Sarma MS, Saraswat VA, Mohindra S, Yadav RR, Kumar S. Childhood pancreatic trauma: Clinical presentation, natural history and outcome. Pancreatology 2020; 20:68-73. [PMID: 31706820 DOI: 10.1016/j.pan.2019.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/06/2019] [Accepted: 10/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To study the presentation, management strategies and long-term natural history of children with pancreatic trauma. METHODS Children admitted with pancreatic trauma were analyzed for their presentation, management and outcome. Management included nasojejunal feeds, total parenteral nutrition (TPN), octreotide, drainage (radiological and endoscopic), endoscopic retrograde cholangiopancreatography (ERCP) and surgery. Patients were assessed in follow-up for development of chronic pancreatitis (CP). RESULTS 36 children [29 boys, age 144 (13-194) months] presented at 30 (3-210) days after trauma. Most common cause of trauma was bicycle handle bar injury [n = 18,50%]. Presenting features were abdominal pain [n = 26,72%], lump [n = 16, 44.4%], ascites [n = 13,36%], pleural effusion [n = 9,25%] and anasarca [n = 3,8.3%]. All presented with sequelae of ductal disruption with pseudocyst, ascites or pleural effusion. Fifteen (41.6%) patients each had Grade III and IV injury, 4 (11%) had grade V, and grading was unavailable in 2. Other organs were injured in 4 (11%) cases. Management consisted of various combinations of nasojejunal feeds [n = 17,47.2%], TPN [n = 5,13.8%], octreotide [n = 13,36%], pseudocyst drainage [radiological (n = 18,50%), endoscopic (n = 3,8.3%)] and ERCP [n = 12,33.3%]. Surgical intervention was done in 2 (5.5%) cases [cystojejunostomy and peritoneal lavage in 1 each]. Two (5.5%) patients died due to sepsis. Of the 32 cases in follow-up, 19 (59.3%) recovered and 13 (40.6%) developed CP, with half (6/13) of them being symptomatic with recurrent pain. CONCLUSION Multi-disciplinary non-operative management is effective for managing pancreatic trauma in 94.4% of children, with 75% requiring radiological or endoscopic intervention. 40% developed structural changes later but only half were symptomatic.
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Affiliation(s)
- Aathira Ravindranath
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vivek A Saraswat
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Samir Mohindra
- Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rajanikant R Yadav
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sheo Kumar
- Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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4
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Approach and Management of Traumatic Retroperitoneal Injuries. Cir Esp 2018; 96:250-259. [PMID: 29656797 DOI: 10.1016/j.ciresp.2018.02.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 02/26/2018] [Accepted: 02/27/2018] [Indexed: 11/23/2022]
Abstract
Traumatic retroperitoneal injuries constitute a challenge for trauma surgeons. They usually occur in the context of a trauma patient with multiple associated injuries, in whom invasive procedures have an important role in the diagnosis of these injuries. The retroperitoneum is the anatomical region with the highest mortality rates, therefore early diagnosis and treatment of these lesions acquire special relevance. The aim of this study is to present current published scientific evidence regarding incidence, mechanism of injury, diagnostic methods and treatment through a review of the international literature from the last 70 years. In conclusion, this systematic review showed an increasing trend towards non-surgical management of retroperitoneal injuries.
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Affiliation(s)
- A N Smolyar
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - K T Agakhanova
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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Petrone P, Moral Álvarez S, González Pérez M, Ceballos Esparragón J, Marini CP. Pancreatic trauma: Management and literature review. Cir Esp 2016; 95:123-130. [PMID: 27480036 DOI: 10.1016/j.ciresp.2016.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/13/2016] [Accepted: 05/22/2016] [Indexed: 12/11/2022]
Abstract
Pancreatic injury is an uncommon event often difficult to diagnose at an early stage. After abdominal trauma, the surgeon must always be aware of the possibility of pancreatic trauma due to the complications associated with missed pancreatic injuries. Due to its retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extra abdominal injuries explain the high morbidity and mortality. The aim of this study is to present a concise description of the incidence of these injuries, lesional mechanisms, recommended diagnostic methods, therapeutic indications including nonoperative management, endoscopy and surgery, and an analysis of pancreas-specific complications and mortality rates in these patients based on a 60-year review of the literature, encompassing 6,364 patients. Due to pancreatic retroperitoneal position, asociated organs and vascular injuries are almost always present, which along with frequent extraaabdominal injuries explain the high morbidity and mortality of these patients.
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Affiliation(s)
- Patrizio Petrone
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU..
| | - Sara Moral Álvarez
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - Marta González Pérez
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - José Ceballos Esparragón
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - Corrado P Marini
- Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, Department of Surgery New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
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Kim DH. Isolated Traumatic Injury of the Pancreatic Head: A Case Report. JOURNAL OF TRAUMA AND INJURY 2016. [DOI: 10.20408/jti.2016.29.2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dong Hun Kim
- Department of Surgery, Trauma Center, Dankook University Hospital, Cheonan, Korea
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Krige J, Kotze U, Nicol A, Navsaria P. Isolated pancreatic injuries: An analysis of 49 consecutive patients treated at a Level 1 Trauma Centre. J Visc Surg 2015; 152:349-55. [DOI: 10.1016/j.jviscsurg.2015.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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10
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López Penza P, Rosso E, Marzano E, Oussoultzoglou E, Bachellier P. [Emergent central pancreatectomy for a blunt abdominal trauma]. Cir Esp 2013; 91:545-6. [PMID: 23827924 DOI: 10.1016/j.ciresp.2013.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 02/25/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Patricia López Penza
- Service de Chirurgie Générale, Hépatique et Endocrinienne, Hôpital Universitaire de Hautepierre, Estrasburgo Cedex, Francia.
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Fonseca AZ, Ribeiro MAF, Contrucci O, Pompeo A, Orsetti A, Neto HA. Spleen preserving distal pancreatectomy in an isolated blunt pancreatic trauma. World J Gastrointest Surg 2011; 3:138-41. [PMID: 22007283 PMCID: PMC3192224 DOI: 10.4240/wjgs.v3.i9.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 07/26/2011] [Accepted: 08/05/2011] [Indexed: 02/06/2023] Open
Abstract
Blunt isolated pancreatic trauma is uncommon, accounting for 1%-4% of high impact abdominal injuries. In addition, its diagnosis can be difficult; physical signs may be poor and laboratory findings nonspecific, resulting in delayed treatment. Preserving the spleen during distal pancreatectomy (DP) is controversial. One of the spleen’s functions regards immunity; complications following splenectomy include leukocytosis, thrombocytosis, overwhelming post splenectomy sepsis and some degree of immunodeficiency. This is why many authors favor its preservation. We describe a case of a young man with an isolated pancreatic trauma due to a blunt abdominal trauma with a delayed presentation who was treated with spleen-preserving DP and we discuss the value of this procedure with reference to the literature.
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Affiliation(s)
- Alexandre Zanchenko Fonseca
- Alexandre Zanchenko Fonseca, Marcelo Augusto Fontenelle Ribeiro Jr, Orlando Contrucci, Alexandre Pompeo, Adriana Orsetti, Herico Arsie Neto, Department of General Surgery, University of Santo Amaro, São Paulo-SP, CEP 04601-060, Brazil
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Korontzi MI, Kontovounisios C, Karaliotas CC, Lanitis S, Sgourakis G, Papakostantinou T, Karaliotas C. The current management of pancreatic trauma. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s13126-010-0056-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
Left pancreatic traumas (LPTs) are rare but serious lesions occurring in 1 to 6 per cent of abdominal trauma patients and mainly resulting from blunt traumas. LPT severity is primarily dependent on the associated injuries and secondarily related to main pancreatic duct injury responsible for complications: acute pancreatitis, pseudocysts, pancreatic fistulas, or abscesses. The guidelines for blunt LPT management can be presented as follows. In case of emergency laparotomy, pancreas exploration is mandatory to detect pancreatic duct lesions. In the absence of main pancreatic duct lesions, simple drainage is advocated. In case of distal injury to the main pancreatic duct, a left pancreatectomy is mandatory. In the absence of initial laparotomy, the diagnosis is more and more based on CT and magnetic resonance cholangiopancreatography, which tend to replace endoscopic retrograde cholangiopancreatography (ERCP) as a first-intent diagnostic modality. In case of distal injury to the main pancreatic duct, spleen-preserving distal pancreatectomy is recommended. In the absence of main pancreatic duct lesions, nonoperative treatment is advocated. When LPTs are discovered at the time of complications, pancreatic fistulas and/or pseudocysts are associated with main pancreatic lesions, which can be treated by pancreatic duct stenting at ERCP and/or internal endoscopic cystogastrostomy. However, in such cases, spleen-preserving distal pancreatectomy remains the treatment of choice. Pancreatic ductal lesions resulting from LPT have to be diagnosed early to avoid late complications. Distal pancreatectomy remains the treatment of choice in case of severe pancreatic ductal lesions because the role of ERCP stenting and endoscopic techniques needs further evaluation.
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Affiliation(s)
- Brice Malgras
- Visceral Surgery Unit, Val de Grace University Military Hospital, Paris, France
| | - Richard Douard
- Digestive and Endocrinian Surgery Unit, Cochin AP-HP University Hospital, Paris, France
- Paris-Descartes Faculty of Medicine, Paris V University, Paris, France
| | - Nathalie Siauve
- Paris-Descartes Faculty of Medicine, Paris V University, Paris, France
- Radiology Unit, Georges Pompidou AP-HP University Hospital, Paris, France
| | - Philippe Wind
- General and Digestive Surgery Unit, Avicenne AP-HP University Hospital, Bobigny, France
- Faculté de Médecine de Bobigny, Université Paris XIII, Bobigny, France
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Mesquita J, Varela A, Medina JL. Trauma and the endocrine system. ENDOCRINOLOGIA Y NUTRICION : ORGANO DE LA SOCIEDAD ESPANOLA DE ENDOCRINOLOGIA Y NUTRICION 2010; 57:492-499. [PMID: 20850396 DOI: 10.1016/j.endonu.2010.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 06/18/2010] [Accepted: 06/25/2010] [Indexed: 05/29/2023]
Abstract
The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma.
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Affiliation(s)
- Joana Mesquita
- Endocrinology Department of Hospital de São João-EPE, Porto, Portugal.
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Doley RP, Yadav TD, Kang M, Dalal A, Jayant M, Sharma R, Wig JD. Traumatic Transection of Pancreas at the Neck: Feasibility of Parenchymal Preserving Strategy. Gastroenterology Res 2010; 3:79-85. [PMID: 27956990 PMCID: PMC5139874 DOI: 10.4021/gr2010.02.163w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2010] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To assess the feasibility and safety of a pancreas preserving operative technique in the management of isolated complete pancreatic neck transection following blunt abdominal trauma. METHODS Two patients with isolated blunt fracture of the pancreatic neck underwent pancreas preserving procedure comprising of oversewing of the proximal pancreas and Roux-en-Y pancreatico jejunostomy to the distal remnant. A feeding jejunostomy tube was placed for postoperative nutritional support in these patients. Both patients received subcutaneous octreotide 300 µg/day. RESULTS Their ages ranged from 15 years to 20 years, mode of injury was bicycle handle-bar injury (n = 2). Both had pancreatic transection at neck in the line of superior mesenteric vessels. One had ascites. These patients had pancreas parenchyma preserving surgery - internal drainage of the left remnant in a Roux-en-Y jejunal loop. The postoperative course was uneventful in these and both are well on follow-up. CONCLUSIONS Pancreas preserving strategy - suture of head side of pancreas and an internal drainage of left remnant with a Roux-en-Y jejunal loop is feasible and safe and should be considered in selected cases. Substantial amount of normal pancreatic parenchyma is preserved.
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Affiliation(s)
- Rudra Prasad Doley
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Thakur Deen Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | - Jai Dev Wig
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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