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Naragund AV, Muddasetty R, Kumar SS. Revisiting the Conundrum: A Case Report on Trauma Whipple's Pancreaticoduodenectomy. Cureus 2022; 14:e27189. [PMID: 36039270 PMCID: PMC9395760 DOI: 10.7759/cureus.27189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2022] [Indexed: 11/13/2022] Open
Abstract
Despite its rarity, pancreatic trauma is a serious condition because of its retroperitoneal location, association with other organ injuries, and complex bilio-vascular anatomy. Even less common are isolated pancreatic injuries. In grade four injuries, there is a debate over resectional vs. non-resectional management and appropriate treatment is particularly difficult. Here we discuss a patient with grade four pancreatic injury with pancreatic ascites presenting four days after the incident and traumatic pancreatitis. She underwent pylorus-preserving pancreatoduodenectomy and recovered well with acceptable morbidity.
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Nagashima F, Inoue S, Matsui D, Bansyoutani Y, Tokuda R, Fuzisaki O, Kobayashi M. Efficacy of damage control surgery and staged endoscopic pancreatic ductal double stenting therapy for severe pancreatic head injury: a case report. J Med Case Rep 2021; 15:404. [PMID: 34384492 PMCID: PMC8362013 DOI: 10.1186/s13256-021-02995-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A high-grade pancreatic injury is a life-threatening injury that is associated with high mortality and morbidity. It is currently unclear which treatment strategy results in good clinical outcomes. CASE PRESENTATION A 23-year-old Japanese woman sustained severe injury in a motor vehicle accident. Abdominal computed tomography revealed severe pancreatic head injury with extravasation of contrast media. Since it was not possible to insert an endoscopic pancreatic stenting tube into the main pancreatic duct, damage control surgery was performed. On day 3, we could insert the endoscopic pancreatic stenting tube from the ampulla of Vater and an endoscopic nasopancreatic drainage tube in the distal pancreatic duct from the accessory ampulla before the second operation. Drainage tubes were placed around the pancreatic head in the second operation. The endoscopic nasopancreatic drainage tube tube was converted to endoscopic pancreatic stenting tube on day 9. On day 51, the patient was discharged on foot from our hospital without serious complications. CONCLUSION Early and effective hemostasis, staged pancreatic duct drainage with stenting, and surgical external drainage around the pancreas in combination with an endoscopic procedure and damage control surgery were considered appropriate therapeutic strategy for high-grade pancreatic injury.
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Affiliation(s)
- Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan.
| | - Satoshi Inoue
- Inoue Clinic, 2-18-2 Togire, Nishi-ku, Fukuoka, 819-0032, Japan
| | - Daisaku Matsui
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan
| | - Yuki Bansyoutani
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan
| | - Rina Tokuda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan
| | - Osamu Fuzisaki
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan
| | - Makoto Kobayashi
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan
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Zhang D, Yan J, Siyin ST, Pang W, Chen Y. Nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children: a single center's experience. BMC Pediatr 2021; 21:75. [PMID: 33573611 PMCID: PMC7877105 DOI: 10.1186/s12887-021-02535-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background The treatment of high-grade (III/IV/V) blunt pancreatic injuries remains controversial. The study aims to summarize and evaluate nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children. Methods Twenty children [6.9 (3–12) years] treated at our center between January 2010 and June 2018 were included in this study. Their medical records and the outpatient follow-up data within 12 weeks after discharge were retrospectively reviewed. Long-term follow-up was conducted by telephone in February 2020. Results Nine children developed complications, including 8 pancreatic pseudocysts and 1 abdominal infection, after treatment at external hospitals and were transferred to our center with an average length of stay of 33.8 (8–63) days. Eleven children were admitted to our hospital directly after injury, with an average length of stay of 47.5 (23–69) days. One child underwent emergency laparotomy for hemorrhagic shock and Roux-en-Y drainage of the distal pancreas. The remaining 10 children received conservative treatment: 7 developed pancreatic pseudocysts, 2 developed abdominal infections, and 1 recovered uneventfully. For children with pancreatic pseudocysts (15/20, 75.0%), 4 recovered after conservative treatment, 4 recovered after percutaneous puncture, 5 recovered after external drainage of the cyst, and 2 recovered after alimentary tract anastomosis. Three children (3/20, 15.0%) who developed abdominal infection recovered after abdominal irrigation and drainage. No child was admitted to the ICU or died. Four children (4/20, 20.0%) developed local pancreatic atrophy within 12 weeks after discharge, but no other long-term complications were observed. Conclusions Nonresection management of the pancreas could be a feasible option for children with grade III and IV blunt pancreatic injuries. Regular long-term follow-up is essential in terms of pancreatic function, especially in patients with pancreatic atrophy.
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Affiliation(s)
- Dan Zhang
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Sarah Tan Siyin
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China. .,, Beijing, People's Republic of China.
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Søreide K, Weiser TG, Parks RW. Clinical update on management of pancreatic trauma. HPB (Oxford) 2018; 20:1099-1108. [PMID: 30005994 DOI: 10.1016/j.hpb.2018.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic injury is rare and optimal diagnosis and management is still debated. The aim of this study was to review the existing data and consensus on management of pancreatic trauma. METHODS Systematic literature review until May 2018. RESULTS Pancreas injury is reported in 0.2-0.3% of all trauma patients. Severity is scored by the organ injury scale (OIS), with new scores including physiology needing validation. Diagnosis is difficult, clinical signs subtle, and imaging by ultrasound (US) and computed tomography (CT) non-specific with <60% sensitivity for pancreatic duct injury. MRCP and ERCP have superior sensitivity (90-100%) for detecting ductal disruption. Early ERCP with stent is a feasible approach for initial management of all branch-duct and most main-duct injuries. Distal pancreatectomy (±splenectomy) may be required for a transected gland distal to the major vessels. Early peripancreatic fluid collections are common in ductal injuries and one-fifth may develop pseudocysts, of which two-thirds can be managed conservatively. Non-operative management has a high success rate (50-75%), even in high-grade injuries, but associated with morbidity. Mortality is related to associated injuries. CONCLUSION Pancreatic injuries are rare and can often be managed non-operatively, supported by percutaneous drainage and ductal stenting. Distal pancreatectomy is the most common operative procedure.
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Affiliation(s)
- Kjetil Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway.
| | - Thomas G Weiser
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Stanford University Department of Surgery, Section of Trauma and Critical Care, Stanford, CA, USA
| | - Rowan W Parks
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK
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Yang X, Aghajafari P, Goussous N, Patel ST, Cunningham SC. The "Colonial Wig" pancreaticojejunostomy: zero leaks with a novel technique for reconstruction after pancreaticoduodenectomy. Hepatobiliary Pancreat Dis Int 2017; 16:545-551. [PMID: 28992888 DOI: 10.1016/s1499-3872(17)60053-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 06/22/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains common and morbid after pancreaticoduodenectomy (PD). A major advance in the study of POPF is the fistula risk score (FRS). METHODS We analyzed 48 consecutive patients undergoing PD. The "Colonial Wig" pancreaticojejunostomy (CWPJ) technique was used in the last 22 PDs, we compared 22 CWPJ to 26 conventional PDs. RESULTS Postoperative morbidity was 49% (27% Clavien grade >2). The median length of hospital stay was 11 days. In the first 26 PDs, the PJ was performed according to standard techniques and the clinically relevant POPF (CR-POPF) rate was 15%, similar to the FRS-predicted rate (14%). In the next 22 PJs, the CWPJ was employed. Although the FRS-predicted rates were similar in these two groups (14% vs 13%), the CR-POPF rate in the CWPJ group was 0 (P=0.052). CONCLUSION Early experience with the CWPJ is encouraging, and this anastomosis may be a safe and effective way to lower POPF rates.
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Affiliation(s)
- Xihua Yang
- Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA
| | - Pouya Aghajafari
- Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA
| | - Naeem Goussous
- Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA
| | - Shirali T Patel
- Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA
| | - Steven C Cunningham
- Department of Surgery, Saint Agnes Hospital and Cancer Center, Baltimore, MD, USA.
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The role of surgery in the treatment of endoscopic complications. Best Pract Res Clin Gastroenterol 2016; 30:841-851. [PMID: 27931640 DOI: 10.1016/j.bpg.2016.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 09/05/2016] [Accepted: 10/02/2016] [Indexed: 01/31/2023]
Abstract
As the number, diversity, and complexity of endoscopic complications has increased, so too has the number, diversity, and complexity of operative interventions required to treat them. The most common complications of endoscopy in general are bleeding and perforation, but each endoscopic modality has specific nuances of these and other complications. Accordingly, this review considers the surgical complications of endoscopy by location within the gastrointestinal tract, as opposed to by complication types, since there are many complication types that are specific for only one or few locations, such as buried-bumper syndrome after percutaneous endoscopic gastrostomy and pancreatitis after endoscopic retrograde cholangiopancreatography, and since the management of a given complication, such as perforation, may be vastly different in one area than in another area, such as perforations of the esophagus versus the retroperitoneal duodenum versus the intraperitoneal duodenum. It is hoped that this review will provide guidance for gastroenterologists considering a particular procedure, either to assess the risks for surgical complications in preparation for patient counseling, or assist in assessing a patient who seems to be having a severe complication, or to learn what operation might be required to treat a given complication and how that operation might be performed. As with many operations, those for the treatment of endoscopic complications are typically performed only when less invasive, nonoperative strategies fail.
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Bugiantella W, Rondelli F, Boni M, Stella P, Polistena A, Sanguinetti A, Avenia N. Necrotizing pancreatitis: A review of the interventions. Int J Surg 2015; 28 Suppl 1:S163-71. [PMID: 26708848 DOI: 10.1016/j.ijsu.2015.12.038] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 04/11/2015] [Accepted: 05/10/2015] [Indexed: 02/06/2023]
Abstract
Acute pancreatitis may have a wide range of severity, from a clinically self-limiting to a quickly fatal course. Necrotizing pancreatitis (NP) is the most dreadful evolution associated to a poor prognosis: mortality is approximately 15% and up to 30-39% in case of infected necrosis, which is the major cause of death. Intervention is generally required for infected pancreatic necrosis and less commonly in patients with sterile necrosis who are symptomatic (gastric or duodenal outlet or biliary obstruction). Traditionally the most widely used approach to infected necrosis has been open surgical necrosectomy, but it is burdened by high morbidity (34-95%) and mortality (11-39%) rates. In the last two decades the treatment of NP has significantly evolved from open surgery towards minimally invasive techniques (percutaneous catheter drainage, per-oral endoscopic, laparoscopy and rigid retroperitoneal videoscopy). The objective of this review is to summarize the current state of the art of the management of NP and to clarify some aspects about its diagnosis and treatment.
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Affiliation(s)
- Walter Bugiantella
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, PhD School in Biotechnologies, Italy.
| | - Fabio Rondelli
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy; University of Perugia, Department of Surgical and Biomedical Sciences, Via G. Dottori, 06100, Perugia, Italy.
| | - Marcello Boni
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - Paolo Stella
- General Surgery, "San Giovanni Battista Hospital", AUSL Umbria 2, Via M. Arcamone, 06034, Foligno, Perugia, Italy.
| | - Andrea Polistena
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
| | - Alessandro Sanguinetti
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
| | - Nicola Avenia
- General and Specialized Surgery, "Santa Maria" Hospital, Via T. Di Joannuccio, 05100, Terni, Italy.
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Traumatic pancreatic transection with abdomino-pelvic pseudocyst formation. J Pediatr 2015; 166:1094-e1. [PMID: 25661401 DOI: 10.1016/j.jpeds.2014.12.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 12/19/2014] [Indexed: 11/22/2022]
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Kawahara I, Maeda K, Ono S, Kawashima H, Deie R, Yanagisawa S, Baba K, Usui Y, Tsuji Y, Fukuta A, Sekine S. Surgical reconstruction and endoscopic pancreatic stent for traumatic pancreatic duct disruption. Pediatr Surg Int 2014; 30:951-6. [PMID: 25070690 DOI: 10.1007/s00383-014-3570-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 12/26/2022]
Abstract
Nonoperative management is acceptable treatment for minor pancreatic injuries. However, management of major pancreatic duct injury in children remains controversial. We present our experience in treating isolated pancreatic duct injury. We describe the cases of three male patients treated for complete pancreatic duct disruption in the past 5 years at our institution. We performed pancreatic duct repair to avoid distal pancreatectomy and to maintain normal pancreatic function. All patients underwent enhanced computed tomography and endoscopic retrograde cholangiopancreatography in the early period. The injuries were classified as grade III according to the American Association for the Surgery of Trauma classification. In two cases, we performed end-to-end anastomosis of the pancreatic duct during the delayed period. In the third case, we placed a stent across the disruption to the distal pancreatic duct. The patients' postoperative courses were uneventful, and the average hospitalization was 25.6 days after the procedure. At a median follow-up of 36 months (range 14-54 months), all patients remain asymptomatic, with normal pancreatic function, but with persistent distal pancreatic duct dilatation. We suggest that distal pancreatectomy should not be routinely performed in patients with isolated pancreatic duct injury.
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Affiliation(s)
- Insu Kawahara
- Division of Pediatric Surgery, Department of Surgery, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
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