Pavlidis ET, Psarras K, Symeonidis NG, Geropoulos G, Pavlidis TE. Indications for the surgical management of pancreatic trauma: An update. World J Gastrointest Surg 2022; 14(6): 538-543 [PMID: 35979422 DOI: 10.4240/wjgs.v14.i6.538]
Corresponding Author of This Article
Theodoros Efstathios Pavlidis, PhD, Chief Doctor, Director, Full Professor, Surgeon, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Efstathios Theodoros Pavlidis, Kyriakos Psarras, Nikolaos G Symeonidis, Theodoros Efstathios Pavlidis, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
Georgios Geropoulos, Department of General Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
Author contributions: Pavlidis TE designed the research, contributed new analytic tools and analyzed the data; Pavlidis ET performed the research and wrote the paper; Psarras K, Symeonidis NG, Geropoulos G analyzed the data and reviewed the data.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior author or other coauthors contributed their efforts in this manuscript.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Theodoros Efstathios Pavlidis, PhD, Chief Doctor, Director, Full Professor, Surgeon, 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Konstantinoupoleos 49, Thessaloniki 54642, Greece. pavlidth@auth.gr
Received: January 3, 2022 Peer-review started: January 3, 2022 First decision: March 12, 2022 Revised: March 17, 2022 Accepted: May 12, 2022 Article in press: May 12, 2022 Published online: June 27, 2022
Abstract
Pancreatic trauma is rare compared to other abdominal solid organ injuries, accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade III to grade V injuries.
Core Tip: Pancreatic trauma management should be individualized based on the exact grade of injury. Damage control surgery is the best approach for severe life-threatening cases. However, in such cases, the presence of severe acute pancreatitis makes safe resection impossible. Endoscopic stent placement into the ruptured pancreatic duct is the best alternative after the acute phase. In cases in which local conditions allow, pancreaticojejunostomy can be performed.
