Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2022; 14(5): 342-350
Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.342
Intraoperative endoscopic retrograde cholangiopancreatography for traumatic pancreatic ductal injuries: Two case reports
Andrew Canakis, Varun Kesar, Caleb Hudspath, Raymond E Kim, Thomas M Scalea, Peter Darwin
Andrew Canakis, Varun Kesar, Caleb Hudspath, Raymond E Kim, Peter Darwin, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Thomas M Scalea, Department of Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, United States
Author contributions: Canakis A reviewed the literature and drafted manuscript; Kesar V, Hudspath C, Kim RE, and Darwin P participated in the therapeutic endoscopic care of the patient; Scalea TM was the patient’s trauma surgeon; Darwin P conceptualized the case series idea; Darwin P and Scalea TM provided critical revisions; all authors have read and approve the final manuscript.
Informed consent statement: Informed Consent was obtained for this case series.
Conflict-of-interest statement: Raymond Kim is a consultant to Medtronic and Cook medical. All other authors have no potential conflicts (financial, professional, or personal) that are relevant to the content presented in this manuscript.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Peter Darwin, MD, Professor, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, No. 22 South Greene Street, Baltimore, MD 21201, United States.
Received: January 15, 2022
Peer-review started: January 15, 2022
First decision: March 8, 2022
Revised: March 9, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: May 16, 2022

In order to successfully manage traumatic pancreatic duct (PD) leaks, early diagnosis and operative management is paramount in reducing morbidity and mortality. In the acute setting, endoscopic retrograde cholangiopancreatography (ERCP) can be a useful, adjunctive modality during exploratory laparotomy. ERCP with sphincterotomy and stent placement improves preferential drainage in the setting of injury, allowing the pancreatic leak to properly heal. However, data in this acute setting is limited.


In this case series, a 27-year-old male and 16-year-old female presented with PD leaks secondary to a gunshot wound and blunt abdominal trauma, respectively. Both underwent intraoperative ERCP within an average of 5.9 h from time of presentation. A sphincterotomy and plastic pancreatic stent placement was performed with a 100% technical and clinical success. There were no associated immediate or long-term complications. Following discharge, both patients underwent repeat ERCP for stent removal with resolution of ductal injury.


These experiences further demonstrated that widespread adaption and optimal timing of ERCP may improve outcomes in trauma centers.

Keywords: Pancreatic ductal injury, Pancreatic leaks, Endoscopic retrograde cholangiopancreatography, Trauma, Endoscopic stenting, Case report

Core Tip: In the acute setting, intraoperative endoscopic retrograde cholangiopancreatography (ERCP) can effectively diagnosis and manage pancreatic duct (PD) injuries with stenting. At our high-volume trauma center, the on call therapeutic endoscopy team allows for quick and effective mobilization of resources. In this series, the time from admission to ERCP occurred within 6.3 and 5.6 h. The pancreatic injuries healed, and both stents were removed. In cases of traumatic PD injury, we believe that advanced gastroenterology care has the opportunity to improve the timing of diagnosis and treatment as a means to potentially reduce the morbidity and mortality associated with such injuries.