Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.834
Peer-review started: December 3, 2022
First decision: January 12, 2023
Revised: January 22, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: May 27, 2023
The management of high-grade pancreatic trauma is controversial.
To review our single-institution experience on the surgical management of blunt and penetrating pancreatic injuries.
A retrospective review of records was performed on all patients undergoing surgical intervention for high-grade pancreatic injuries [American Association for the Surgery of Trauma (AAST) Grade III or greater] at the Royal North Shore Hospital in Sydney between January 2001 and December 2022. Morbidity and mortality outcomes were reviewed, and major diagnostic and operative challenges were identified.
Over a twenty-year period, 14 patients underwent pancreatic resection for high-grade injuries. Seven patients sustained AAST Grade III injuries and 7 were classified as Grades IV or V. Nine underwent distal pancreatectomy and 5 underwent pancreaticoduodenectomy (PD). Overall, there was a predominance of blunt aetiologies (11/14). Concomitant intra-abdominal injuries were observed in 11 patients and traumatic haemorrhage in 6 patients. Three patients developed clinically relevant pancreatic fistulas and there was one in-hospital mortality secondary to multi-organ failure. Among stable presentations, pancreatic ductal injuries were missed in two-thirds of cases (7/12) on initial computed tomography imaging and subsequently diagnosed on repeat imaging or endoscopic retrograde cholangiopancreatography. All patients who sustained complex pancreaticoduodenal trauma underwent PD without mortality. The management of pancreatic trauma is evolving. Our experience provides valuable and locally relevant insights into future management strategies.
We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Pancreatic resections including PD may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.
Core Tip: The management of pancreatic trauma is evolving. This study presents a single-centre series of patients undergoing operative management for pancreatic trauma in Australia. We advocate that high-grade pancreatic trauma should be managed in high-volume hepato-pancreato-biliary specialty surgical units. Penetrating and blunt trauma presentations are associated with varied patterns of injury. There is a growing role for endovascular and endoscopic techniques in the contemporary management of pancreatic trauma. Pancreatic resections including pancreaticoduodenectomy may be indicated and safely performed with appropriate specialist surgical, gastroenterology, and interventional radiology support in tertiary centres.