• Blunt abdominal trauma
• Modular one-stage emergent pancreaticoduodenectomy (MOEPD)
• Pancreaticojejunostomy
• Surgical techniques

• Humans
• Pancreaticoduodenectomy/methods
• Wounds, Nonpenetrating/surgery
• Male
• Middle Aged
• Abdominal Injuries/surgery
• Female
• Adult
• Aged
• Pancreas/injuries
• Pancreas/surgery
• Postoperative Complications/epidemiology
• Young Adult
• Retrospective Studies
• Duodenum/surgery
• Duodenum/injuries
• Treatment Outcome
• Laparoscopy/methods
• China/epidemiology

• Q202239 Scientific Research Project of Wuxi Health Commission (Youth Project)
• 2020SF16 Special Fund for Scientific and Technological Innovation Project of Yixing( Social Development )

• damage control surgery
• grade v
• pancreaticoduodenectomy(pd)
• traumatic pancreatic injury
• whipple's procedure

• abdominal injuries
• duodenum
• multiple trauma
• pancreas

• High-grade duodenal injury
• High-grade pancreatic injury
• High-grade pancreaticoduodenal injury
• Trauma Whipple
• Trauma pancreaticoduodenectomy

• Humans
• Pancreaticoduodenectomy/methods
• Male
• Duodenum/injuries
• Duodenum/surgery
• Retrospective Studies
• Female
• Pancreas/injuries
• Pancreas/surgery
• Adult
• Trauma Centers
• Treatment Outcome
• Abdominal Injuries/surgery
• Abdominal Injuries/mortality
• Wounds, Nonpenetrating/surgery
• Wounds, Nonpenetrating/mortality
• Injury Severity Score
• Middle Aged
• Young Adult

• Humans
• Pancreatic Pseudocyst/complications
• Retrospective Studies
• Pancreas/surgery
• Pancreas/injuries
• Wounds, Nonpenetrating/complications
• Wounds, Nonpenetrating/diagnosis
• Wounds, Nonpenetrating/surgery
• Abdominal Injuries/complications
• Thoracic Injuries/complications
• Treatment Outcome
• Injury Severity Score

• blunt abdominal injury
• distal pancreatectomy
• isolated pancreatic injuries

• Adult
• Drainage/statistics & numerical data
• Female
• Humans
• Injury Severity Score
• Male
• Middle Aged
• Pancreas/injuries
• Pancreas/surgery
• Pancreatectomy/statistics & numerical data
• Pancreaticoduodenectomy/statistics & numerical data
• Quality of Life
• Retrospective Studies
• Treatment Outcome
• Young Adult

In recent years, we created and employed a new anastomosis method, “bridging” pancreaticogastrostomy, to treat patients with extremely severe pancreatic injury. This surgery has advantages such as short length of surgery, low secondary trauma, rapid construction of shunts for pancreatic fluid, preventing second surgeries, and achieving good treatment outcomes in clinical practice. However, due to the limited number of clinical cases, there is a lack of strong evidence to support the feasibility and safety of this surgical procedure. Therefore, we carried out animal experiments to examine this procedure, which is reported here.

To examine the feasibility and safety of a new rapid method of pancreaticogastrostomy, “bridging” pancreaticogastrostomy.

Ten Landrace pigs were randomized into the experimental and control groups, with five pigs in each group. “Bridging” pancreaticogastrostomy was performed in the experimental group, while routine mucosa-to-mucosa pancreaticogastrostomy was performed in the control group. After surgery, the general condition, amylase levels in drainage fluid on Days 1, 3, 5, and 7, fasting and 2-h postprandial blood glucose 6 mo after surgery, fasting, 2-h postprandial peripheral blood insulin, and portal vein blood insulin 6 mo after surgery were assessed. Resurgery was carried out at 1 and 6 mo after the former one to examine the condition of the abdominal cavity and firmness and tightness of the pancreaticogastric anastomosis and pancreas.

After surgery, the general condition of the animals was good. One in the control group did not gain weight 6 mo after surgery, whereas significant weight gain was present in the others. There were significant differences on Days 1 and 3 after surgery between the two groups but no differences on Days 5 and 7. There were no differences in fasting and 2-h postprandial blood glucose and fasting and 2-h insulin values of postprandial peripheral blood and portal vein blood 6 mo after surgery between the two groups. One month after surgery, the sinus tract orifice/anastomosis was patent in the two groups. Six months after surgery, the sinus tract orifice/anastomosis was sealed, and pancreases in both groups presented with chronic pancreatitis.

“Bridging” pancreaticogastrostomy is a feasible and safe a means of damage control surgery during the early stage of pancreatic injury.

• Pancreatic trauma
• Damage control surgery
• “Bridging” pancreaticogastrostomy
• Severe pancreatic injury
• Safety

• Abdominal Injuries/classification
• Abdominal Injuries/diagnostic imaging
• Abdominal Injuries/surgery
• Adult
• Cholangiopancreatography, Magnetic Resonance
• Drainage/adverse effects
• Drainage/methods
• Female
• Humans
• Injury Severity Score
• Internationality
• Male
• Middle Aged
• Pancreas/diagnostic imaging
• Pancreas/injuries
• Pancreas/pathology
• Pancreas/surgery
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Pancreatic Ducts/injuries
• Pancreatic Ducts/pathology
• Pancreatic Ducts/surgery
• Retrospective Studies
• Stents
• Tomography, X-Ray Computed/methods
• Trauma Centers
• Wounds, Nonpenetrating/complications
• Wounds, Nonpenetrating/diagnostic imaging
• Wounds, Nonpenetrating/pathology
• Wounds, Penetrating/complications
• Wounds, Penetrating/diagnostic imaging
• Wounds, Penetrating/pathology
• Young Adult

This study describes the successful treatment of two clinical settings of grade V pancreaticoduodenal blunt trauma only possible due to the prompt collaboration of a peripheral trauma hospital and a central hepatobiliary and pancreatic unit.

We reviewed the clinical records of two male patients aged 17 and 47 years old who underwent a two-stage pancreaticoduodenectomy after a previous Damage-Control Surgery (DCS). Both patients were transferred to our Hepatobiliopancreatic Unit 2 days after immediate DCS with haemostasis, debridement, duodenostomy, gastroenterostomy, external drainage and laparostomy. One day after, they both underwent a two-stage Whipple’s procedure with external cannulation of the main bile duct and the main pancreatic duct with seized calibre silicone drains through the skin. The reconstructive phase was performed two weeks later. The first patient had an uneventful post-operative course and was discharged on post-operative day 8. The second patient developed a high debt biliary fistula on post-operative day 5 being submitted to a relaparotomy with extensive peritoneal lavage. After conservative measures the fistula underwent a progressive closure in 15 days, and the patient was discharged at post-operative day 50 without any limitations.

Pancreaticoduodenectomy is a life-saving operation in selected grade V pancreaticoduodenal trauma lesions. DCS is a salvage approach, often performed in peripheral hospitals, making an early referral to an hepatobiliopancreatic centre mandatory to achieve survival in these severely injured patients. A two-staged Whipple’s operation for severe duodenal / pancreatic trauma can be performed safely and may represent a life-saving option under these very unusual circumstances.

• Case reports
• Duodenal trauma
• Pancreatic injury
• Pancreatic trauma
• Pancreaticoduodenectomy

Management of traumatic pancreatic injury is challenging, and mortality and morbidity remain high. Because pancreatic injury is uncommon and strong recommendations for pancreatic injury management are lacking, management is primarily based on institutional practices. We propose our strategy of pancreatic injury management.

We retrospectively reviewed patients with pancreatic injury and evaluated our strategy and outcomes.

From January 2013 to December 2019, 18 patients were included with traumatic pancreatic injury. The median Injury Severity Score was 22 (25–75% interquartile range, 17–34) and probability of survival was 0.87 (25–75% interquartile range, 0.78–0.93). Patients were grouped according to the American Association for the Surgery of Trauma injury grades: grade I, n = 3 (16.7%); II, n = 6 (33.3%); III, n = 7 (38.9%); and IV, n = 2 (11.1%). All patients underwent endoscopic pancreatic ductal evaluation within 1–2 days after admission. Abbreviated surgery because of hemodynamic instability and subsequent open abdominal management were undertaken in one patient with pancreas head injury and two patients with pancreas body/tail injury. Management was by laparotomy for closed suction drain insertion with main ductal endoscopic drainage in six patients, endoscopic ductal drainage only in six patients, and distal pancreatectomy with closed suction drainage and endoscopic drainage in five patients. One patient with grade I injury underwent observation only. Median length of closed suction drainage was 12 days and that of hospital stay was 36 days. The observed mortality during the study period was 0%. Late formation of pseudo‐pancreatic cyst was observed in two patients (11.1%).

Our uniform, simplified strategy offers good outcomes for any pancreatic injury site and any concomitant injuries, even in hemodynamically unstable patients.

• Closed suction drainage
• damage control surgery
• open abdominal management
• pancreatectomy
• traumatic pancreatic injury

• Pancreatic injury
• Pancreaticoduodenectomy
• Trauma

• Mortality
• Pancreatic injury
• Predictive model
• Risk factor
• Surgery

• Adult
• Ampulla
• Bile duct
• Biliary tree
• Classification
• Conservative
• Duodenum
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopy
• Guidelines
• Injury
• Non-operative
• Operative
• Pancreas
• Pediatric
• Surgery
• Trauma

• Abdominal Injuries/surgery
• Bile Ducts, Extrahepatic/injuries
• Bile Ducts, Extrahepatic/surgery
• Duodenum/injuries
• Duodenum/surgery
• Focused Assessment with Sonography for Trauma/methods
• General Surgery/organization & administration
• General Surgery/trends
• Guidelines as Topic
• Humans
• Pancreas/injuries
• Pancreas/surgery
• Tomography, X-Ray Computed/methods
• Trauma Centers/organization & administration
• Triage/methods
• Ultrasonography/methods

• Pancreatic trauma
• incidence
• management strategies
• mortality and morbidity
• outcomes

Conventionally, disconnected pancreatic duct syndrome is treated surgically. Endoscopic management is associated with lesser morbidity and mortality than that observed with surgery and shows similar success rates. However, limited data are available in this context. We evaluated the efficacy of endotherapeutic management for this syndrome.

We prospectively obtained data of patients with disconnected pancreatic duct syndrome between September 2008 and January 2016. Demographic and clinical data were assessed, and factors affecting clinical outcomes were statistically analyzed.

Thirty-one patients underwent 40 endoscopic transpapillary procedures, and 1 patient developed an infection after prosthesis insertion. Etiological contributors to disconnected pancreatic duct syndrome were abdominal trauma (52%) and acute necrotizing pancreatitis (48%). The median interval between the appearance of pancreatic leaks and disconnected pancreatic duct syndrome was 6.6 months (range 0.5–84 months). The median follow-up after the last treatment procedure was 38 months (range 17–99 months). Patients with complete main pancreatic duct disruption in the body/tail showed a low risk of pancreatic atrophy (P = 0.009). This study highlighted the significant correlation between endoscopic transpapillary drainage and clinical success (P = 0.014).

Disconnected pancreatic duct syndrome is not an uncommon sequel of pancreatic injury, and much of the delayed diagnosis is attributable to a lack of knowledge regarding this disease. Endoscopic transpapillary intervention with ductal stenting is an effective and safe treatment for this condition.

• Acute abdominal trauma
• Acute necrotizing pancreatitis
• Endoscopic retrograde cholangiopancreatography
• Pancreatic fistula

• Blast injuries
• Damage control strategy
• Hemorrhagic shock
• Lack of resources
• Terrorist attack trauma

To benchmark severity of complications using the Accordion Severity Grading System (ASGS) in patients undergoing operation for severe pancreatic injuries.

A prospective institutional database of 461 patients with pancreatic injuries treated from 1990 to 2015 was reviewed. One hundred and thirty patients with AAST grade 3, 4 or 5 pancreatic injuries underwent resection (pancreatoduodenectomy, n = 20, distal pancreatectomy, n = 110), including 30 who had an initial damage control laparotomy (DCL) and later definitive surgery. AAST injury grades, type of pancreatic resection, need for DCL and incidence and ASGS severity of complications were assessed. Uni- and multivariate logistic regression analysis was applied.

Overall 238 complications occurred in 95 (73%) patients of which 73% were ASGS grades 3-6. Nineteen patients (14.6%) died. Patients more likely to have complications after pancreatic resection were older, had a revised trauma score (RTS) < 7.8, were shocked on admission, had grade 5 injuries of the head and neck of the pancreas with associated vascular and duodenal injuries, required a DCL, received a larger blood transfusion, had a pancreatoduodenectomy (PD) and repeat laparotomies. Applying univariate logistic regression analysis, mechanism of injury, RTS < 7.8, shock on admission, DCL, increasing AAST grade and type of pancreatic resection were significant variables for complications. Multivariate logistic regression analysis however showed that only age and type of pancreatic resection (PD) were significant.

This ASGS-based study benchmarked postoperative morbidity after pancreatic resection for trauma. The detailed outcome analysis provided may serve as a reference for future institutional comparisons.

• Pancreas
• Injury
• Complications
• Accordion classification

• Abdominal Injuries/complications
• Cholangiopancreatography, Magnetic Resonance/methods
• Conservative Treatment
• Diagnostic Errors/prevention & control
• Early Diagnosis
• Humans
• Laparotomy/methods
• Multidetector Computed Tomography/methods
• Pancreas/diagnostic imaging
• Pancreas/injuries
• Pancreas/surgery
• Pancreatectomy/adverse effects
• Pancreatectomy/methods
• Patient Selection
• Wounds, Nonpenetrating/complications

• Diagnosis
• Diagnóstico
• Incidence
• Incidencia
• Pancreas
• Páncreas
• Tratamiento
• Trauma
• Traumatismo
• Treatment

Although surgery is the preferred treatment for grade III&IV pancreatic trauma, there is a growing movement for non-operative management. in blunt pancreatic trauma. Very few studies compare operative versus non-operative management in adult patients.

Retrospective analysis of a prospectively maintained database was performed from 2004 to 2013 in the department of gastrointestinal surgery, NIMS, Hyderabad. Comparative analysis was performed between patients who failed versus those who were successfully managed with non-operative management.

34 patients had grade III/IV trauma out of which 8 were operated early with the remaining 26 initially under a NOM strategy, 10 of them could be successfully managed without any operation. Post-traumatic pancreatitis, Necrotizing pancreatitis, Ileus, contusion on CT, surrounding organ injuries are independently associated with failure of NOM on a univariate analysis. On multivariate logistic regression presence of necrosis& associated organ injury are factors that predict failure of NOM independently. Development of a pseudocyst is the only significant factor that is associated with a success of NOM.

Non-operative measures should be attempted in a select group of grade III&IV blunt pancreatic trauma. In hemodynamically stable patients with a controlled leak walled off as a pseudocyst without associated organ injuries and pancreatic necrosis, NOM has a higher success rate.

•

Non-operative measures should be attempted in a select group of high grade (grade III/IV) pancreatic trauma.

• AAST: American association for the surgery of trauma
• ISGPF: International study group of pancreatic fistula
• NOM: non-operative management

• Damage control surgery
• Pancreas
• Trauma

Blunt pancreatic trauma is an uncommon injury but has high morbidity and mortality. In modern era of trauma care, pancreatic trauma remains a persistent challenge to radiologists and surgeons alike. Early detection of pancreatic trauma is essential to prevent subsequent complications. However early pancreatic injury is often subtle on computed tomography (CT) and can be missed unless specifically looked for. Signs of pancreatic injury on CT include laceration, transection, bulky pancreas, heterogeneous enhancement, peripancreatic fluid and signs of pancreatitis. Pan-creatic ductal injury is a vital decision-making parameter as ductal injury is an indication for laparotomy. While lacerations involving more than half of pancreatic parenchyma are suggestive of ductal injury on CT, ductal injuries can be directly assessed on magnetic resonance imaging (MRI) or encoscopic retrograde cholangio-pancreatography. Pancreatic trauma also shows temporal evolution with increase in extent of injury with time. Hence early CT scans may underestimate the extent of injures and sequential imaging with CT or MRI is important in pancreatic trauma. Sequential imaging is also needed for successful non-operative management of pancreatic injury. Accurate early detection on initial CT and adopting a multimodality and sequential imaging strategy can improve outcome in pancreatic trauma.

• Computed tomography
• Magnetic resonance imaging
• Pancreatic trauma
• Complications
• Magnetic resonance cholangiopancreatography
• Management
• Pancreatic injury
• Review

• Abdominal injuries
• balloon occlusion
• liver abscess
• pancreaticoduodenectomy
• vacuum packing closure

• Endoscopy
• Fistula
• Injury
• Pancreas
• Pseudocyst
• Surgery

• Damage control laparotomy
• Pancreatoduodenectomy
• Trauma

• Abdominal Injuries/complications
• Abdominal Injuries/diagnosis
• Abdominal Injuries/mortality
• Abdominal Injuries/surgery
• Adolescent
• Adult
• Blood Loss, Surgical/prevention & control
• Blood Volume
• Female
• Humans
• Laparotomy/adverse effects
• Laparotomy/methods
• Male
• Pancreas/diagnostic imaging
• Pancreas/injuries
• Pancreas/surgery
• Pancreaticoduodenectomy/adverse effects
• Pancreaticoduodenectomy/methods
• Retrospective Studies
• South Africa
• Trauma Severity Indices
• Vascular System Injuries/complications
• Vascular System Injuries/diagnosis
• Vascular System Injuries/surgery
• Veins/injuries

• Distal pancreatectomy
• Injury
• Morbidity
• Mortality
• Pancreas

• child
• humans
• pancreas
• pancreas/injuries
• wounds, nonpenetrating
• wounds, nonpenetrating/surgery
• wounds, nonpenetrating/therapy

• Child
• Humans
• Pancreas/injuries
• Wounds, Nonpenetrating/surgery
• Wounds, Nonpenetrating/therapy

• Humans
• Orthopedics
• Physician-Patient Relations
• Retirement/psychology
• Workload