Retrospective Cohort Study
Copyright ©The Author(s) 2023.
World J Gastrointest Surg. May 27, 2023; 15(5): 834-846
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.834
Table 1 Study population and characteristics

Blunt n = 11
Penetrating n = 3
Patient demographics
Age (yr, range)20 (17 - 38)32 (26 – 51)
Sex (male, %)81
Injury characteristics
Motor vehicle accident50
Sporting injury50
Shock (BP < 90 mmHg)31
Associated abdominal injuries
Organ injuries83
Vascular injuries33
Time to operation
< 12 h43
> 12 h70
In-hospital mortality10
Unplanned return to theatre10
Length of stay14.0 (3.1 – 39.0)34.6 (19.7 – 40.4)
Postoperative complication
Postoperative pancreatitis / fistula12
Intraabdominal sepsis22
Table 2 Summary of cases: Blunt abdominal trauma resulting in high-grade pancreatic injuries
Pancreatic injury
Associated injuries
Vascular injury
AAST grade
Haemodynamic stability
Pre-operative transfusion requirements
Investigations prior to OT
Primary procedure, post-injury day
117FFallPancreatic body lacerationSplenic infarct NilIIIStable; FAST positiveNilCTAP; MRCP; ERCP + StentDP and splenectomy, 10 d from injury (undetected injury on initial imaging)Nil20.8Uncomplicated recovery
238F MVAPancreatic head laceration; Associated with intraperitoneal haemorrhage CBD avulsion; Liver laceration; Fractures–ribs; L2-3 transverse processes, right radius NilIVStable2U pRBCsCTAP, MRCPPD, 7 d from injury (transferred from regional centre, initially for conservative management)17.8Persistent intraabdominal collections requiring two CT-guided drainage procedures
336FMVATransected pancreatic neck; Associated with large left retroperitoneal haematoma Right tension pneumothorax; Left haemothorax; Multiple liver lacerations; Small and large bowel perforations; Left renal hilar laceration Transection of left renal artery, suspected thoracic aortic injuryIVUnstableMTP, 26U pRBC, 18 FFP, 5 Plt, 47 Cryo, 1L albumin, 1g TXANoneDP and splenectomyDamage control surgery in hybrid theatre: Laparotomy with four quadrants packing and cross clamping of supracoeliac aorta. Angioembolisation of left renal artery performed; Pancreatic neck transection was noted and a temporary drain placed. Temporary abdominal closure with negative pressure dressing; Ongoing MTP and resuscitation for next 48 hours. Patient remained intubated; Definitive operative intervention 72 h from initial laparotomy: En block resection of distal pancreas and spleen, and distal transverse colonic resection without anastomosis.3.1In-hospital mortality (secondary to multi-organ failure)
429MMBATransected head of pancreasLiver laceration; Duodenal laceration; Radius and proximal phalanx fracturesNilIVUnstable; FAST positive7U pRBCCTAP–deterioration en route to OTEmergency PD, < 24 h from injuryRight wrist ORIF and closed reduction of 5th digit15.0
520MMVATransacted pancreas at junction of tail and body; Associated with major disruption of MPDSplenic lacerationNilIIIStable NilCTAP; ERCP and pancreatogramDP and splenectomy, 2 d from injury Nil13.0Uncomplicated recovery
619MMBATransection of pancreatic tail and large pseudocystChance injury to L1/2 with spinal canal stenosis; Avulsion of L2-4 right transverse processesNilIIIStable; FAST positive NilCTAP; ERCP + StentDP and splenectomy, 1 mo form injury (delayed presentation)Spinal stabilisation, lumbar fusion L1-239.0Uncomplicated recovery
720MMBATransection to tail of pancreas; Associated with MPD rupture and retroperitoneal haematoma Grade IV/V left renal injury; Splenic hilum laceration; Left ulnar fracture and multiple ribs; Penetrating wound to right knee Left renal artery transection IIIStable; FAST positive NilMRCP; ERCP + stent DP and splenectomy, 4 d from injury Removal of Meckel’s diverticulum and appendicectomy; Left ulnar ORIF; Right knee wound washout and debridement 14.0Uncomplicated recovery
817MSporting injuryTransected pancreatic neck and head; Associated with complete disruption of MPDLiver laceration; Scaphoid fracture NilIVStable NilCTAP; ERCPDP and splenectomy, 3 d from injury12.0
918MSporting injuryTransected pancreatic body; Associated with large retroperitoneal collection NilNilIIIStableNilCT 3Phase DP and splenectomy, 3 d form injury Nil15.5Postoperative pancreatitis; Intraabdominal collection requiring CT-guided drainage
1021M Sporting injuryTransected pancreatic body; Associated with large intraperitoneal and retroperitoneal haematomaSplenic laceration and infarctNilIIIUnstable; FAST positive 1U pRBCCTAPDP and splenectomy; Initial CT imaging demonstrating isolated splenic injuryLeft hemicolectomy; Re-look laparotomy and colonic anastomosis 7.7
1124M Sporting injuryTransection at junction of pancreatic neck and body; Associated with complete disruption of MPDHepatic contusionNilIIIStable; FAST negativeNilCTAP; MRCP; ERCP–Proceeded to laparotomy and DPSubtotal pancreatectomy (spleen preserving), 3 d from injury; Missed ductal injury on initial CTNil10.0Uncomplicated recovery
Table 3 Summary of cases: Penetrating abdominal trauma resulting in high-grade pancreatic injuries
Pancreatic Injury
Associated injuries
Vascular injury
AAST Grade
Haemodynamic stability
Pre-operative transfusion requirements
Investigations prior to OT
Primary procedure, post-Injury day
Post-operative course
132MGunshotDevascularisation of head of Pancreas, 4 cm defectCBD; Duodenum, Right kidney (Grade III)IVC, IPDAVStable; FAST scan negativeNilCTAPPD, < 24 h from injuryRight nephrectomy, IVC repair, Extended right hemicolectomy19.7Uncomplicated recovery
251FStabbingTransection of head of pancreasRenal hilumPV; SMV; Middle colic veinIVUnstable; FAST positive2U pRBC; 2U FFP; MTP activatedNonePD, < 24 h from injuryExtended to thoracotomy34.6Intraabdominal sepsis, collections requiring CT-guided drainage
326FStabbingHead and uncinate of pancreasDuodenum, GallbladderIVCVStable; FAST positiveNilCTAP; Mesenteric angiogram (+ Pancreaticoduodenal pseudoaneurysm embolization)PD, < 24 h from injuryIVC repair; Cholecystectomy40.4Intraabdominal collections, Splenic infarct