The Role of Endoscopic Retrograde Pancreatography for Traumatic Pancreatic Duct Injury.
- Author:
Hyun Soo KIM
1
;
Dong Ki LEE
;
Il Whoi KIM
;
Soon Koo BAIK
;
Sang Ok KWON
;
Joong Wha PARK
;
Nam Cheon CHO
;
Byoung Seon RHOE
Author Information
1. Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea. gidept@wonju.yonsei.ac.kr
- Publication Type:Original Article
- Keywords:
ERP;
CT;
Traumatic pancreatic duct injury;
Pancreatic stent
- MeSH:
Early Diagnosis;
Follow-Up Studies;
Humans;
Length of Stay;
Mortality;
Pancreas;
Pancreatic Ducts*;
Peritoneal Cavity;
Stents;
Tomography, X-Ray Computed
- From:Korean Journal of Gastrointestinal Endoscopy
2001;22(2):88-95
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Backgroud/Aims: Because the status of the main pancreatic duct (MPD) is the most important determinant for pancreatic trauma associated morbidity and mortality, early diagnosis and optimal treatment are critical, especially in MPD injury. METHODS: Twenty-three pancreatic trauma patients were divided into two groups according to the interval between trauma and endoscopic retrograde pancreatography (ERP). The clinical and laboratory findings, CT and ERP results were described. The treatment modality and its clinical outcome were assessed according to ERP findings. RESULTS: The pancreatic duct was injured in 14 of the 23 trauma patients: 11 MPD injuries and 3 branching duct injuries. CT scan correctly predicted the MPD injury in only 6 (54.5%) of the 11 patients, whereas ERP correctly demonstrated the origin and the degree of pancreatic duct injury in all patients. Through contrast leakage from the MPD into peritoneal cavity, ERP confirmed an MPD injury in 8 patients and they underwent surgical exploration. Three patients who showed parenchymal leakage from branching duct recovered with conservative treatment. Transpapillary pancreatic stents were successfully inserted into the distrupted MPD in 3 patients who showed that the contrast leakage was confined to the pancreatic parenchyme and they achieved complete resolution of the pancreatic leaks after a 3-month follow-up period. The late ERP group (>72 hours after trauma) had a significantly higher pancreas associated complication rate and a tendency to a longer hospital stay than the early ERP group. CONCLUSIONS: Early ERP is the most useful tool for demonstrating the presence of MPD injury as well as planning the optimal treatment modality according to the degree of pancreatic duct injury.
