Surgical management of high-grade pancreatic injuries: Insights from a high-volume pancreaticobiliary specialty unit

Table 3 Summary of cases: Penetrating abdominal trauma resulting in high-grade pancreatic injuries

Patient		Mechanism	Pancreatic Injury	Associated injuries	Vascular injury	AAST Grade	Haemodynamic stability	Pre-operative transfusion requirements	Investigations prior to OT	Primary procedure, post-Injury day	Other	LOS	Post-operative course
1	32M	Gunshot	Devascularisation of head of Pancreas, 4 cm defect	CBD; Duodenum, Right kidney (Grade III)	IVC, IPDA	V	Stable; FAST scan negative	Nil	CTAP	PD, < 24 h from injury	Right nephrectomy, IVC repair, Extended right hemicolectomy	19.7	Uncomplicated recovery
2	51F	Stabbing	Transection of head of pancreas	Renal hilum	PV; SMV; Middle colic vein	IV	Unstable; FAST positive	2U pRBC; 2U FFP; MTP activated	None	PD, < 24 h from injury	Extended to thoracotomy	34.6	Intraabdominal sepsis, collections requiring CT-guided drainage
3	26F	Stabbing	Head and uncinate of pancreas	Duodenum, Gallbladder	IVC	V	Stable; FAST positive	Nil	CTAP; Mesenteric angiogram (+ Pancreaticoduodenal pseudoaneurysm embolization)	PD, < 24 h from injury	IVC repair; Cholecystectomy	40.4	Intraabdominal collections, Splenic infarct

AAST: American Association for the Surgery of Trauma; FAST: Focused assessment with sonography for trauma; MTP: Massive transfusion protocol; FFP: Fresh frozen plasma; CBD: Common bile duct; IVC: Inferior vena cava; IPDA: Inferior pancreaticoduodenal artery; SMV: Superior mesenteric vein; pRBC: Packed red blood cells; CTAP: Computed tomography abdomen and pelvis; PID: Post injury day; OT: Operating theatre; PD: Pancreaticoduodenectomy; DP: Distal pancreatectomy; LOS: Length of stay.