Diagnosis and Management of High-Grade Pancreatic Trauma: Report of 14 Cases

The aim of this study was to review the diagnosis and operative management of cases of high-grade pancreatic trauma. A retrospective analysis was performed on 14 patients treated for high-grade pancreatic trauma at our institution between December 2008 and November 2013. The patients were treated for injuries resulting from blunt abdominal trauma. The main clinical data of the patients was analyzed, including time to diagnosis, initial serum amylase level, ultrasonography and abdominal computed tomography (CT) findings, pancreatic injury severity as scored according to the American Association for the Surgery of Trauma Organ Injury Scale, injury to other organs, operative treatment method, postoperative complications, and patient outcome. All 14 patients were diagnosed with severe (≥ grade III) pancreatic trauma. Diagnosis was confirmed in all seven hemodynamically stable patients that underwent CT and in 9/13 patients receiving ultrasound examination. All patients underwent surgical operations, including emergency pancreaticoduodenectomy (n = 8), splenectomy with distal pancreatectomy (n = 3), spleen-preserving distal pancreatectomy (n = 1), medial pancreatectomy with Roux-en-Y pancreaticojejunostomy (n = 1), and peripancreatic debridement and drainage (n = 1). Diagnosis was delayed beyond 24 h in two patients, both of whom underwent reoperative peripancreatic debridement and drainage, with one death. The complications included pancreatic fistula (n = 8), peripancreatic abscess (n = 2), hepatic artery hemorrhage (n = 1), gastrointestinal bleeding (n = 1), and intra-abdominal abscess (n = 1). CT is the most reliable method for diagnosing high-grade pancreatic trauma. Aggressive surgical therapy including pancreaticoduodenectomy is acceptable in hemodynamically stable patients.