An isolated pancreatic transection due to blunt trauma is a rare occurrence that usually requires surgical treatment. Non-surgical treatment for a pancreatic transection remains controversial because of its associated complications. On the other hand, non-surgical treatment has been used increasingly as a treatment option with promising results in recent years. A patient presented with a suspected pancreatic injury caused by a motorcycle accident. The computed tomography findings revealed an isolated pancreatic neck transection with a small amount of fluid collection. He was hemodynamically stable without signs of peritoneal irritation. Endoscopic retrograde pancreatography and stent insertion were performed. The patient had no significant complications and was discharged on day 18. The stent was removed on day 103 and the patient showed good recovery. For an isolated pancreatic transection, endoscopic intervention can be considered as an alternative with a good outcome in selected patients.
Hand ; Humans ; Motorcycles* ; Neck ; Pancreas ; Stents ; Wounds and Injuries

A 34-year-old man admitted to our department with complex blunt pancreaticoduodenal injury after a car accident. The wall of the first, second, and third portions of the duodenum was extensively lacerated, and the pancreas was longitudinally transected along the superior mesenteric vein-portal vein trunk. The pancreatic head and the uncinate process were devitalized and the distal common bile duct and the proximal main pancreatic duct were completely detached from the Vater ampulla. The length of the stump of distal common bile located at the cut surface of remnant pancreas was approximately 0.6 cm. A simplified Kausch-Whipple's procedure was performed after debridement of the devitalized pancreatic head and resection of the damaged duodenum in which the stump of distal common bile duct and the pancreatic remnant were embedded into the jejunal loop. Postoperative wound abscess appeared that eventually recovered by conservative treatment. During 16 months follow-up the patient has been stable and healthy. A simplified pancreaticoduodenectomy is a safe alternative for the Whipple procedure in managing complex pancreaticoduodenal injury in a hemodynamically stable patient.
Accidents, Traffic ; Adult ; Duodenum ; injuries ; Humans ; Male ; Pancreas ; injuries ; Pancreaticoduodenectomy ; methods ; Wounds, Nonpenetrating ; surgery

OBJECTIVETo explore the significance of damage control surgery (DCS) in the treatments of severe pancreaticoduodenal injuries.

METHODSClinical data of 19 patients with severe pancreaticoduodenal injuries managed with DCS approach in Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine and the First Affiliated Hospital of Wenzhou Medical College from March 2005 to January 2013 were analyzed retrospectively.

RESULTSThree cases were cured after damage control operation and postoperative ICU resuscitation treatment. Twelve cases underwent definite operations (distal pancreaticojejunal Roux-en-Y anastomosis, proximal duodenojejunal Roux-en-Y anastomosis or pancreaticoduodenectomy) after damage control operation and postoperative ICU resuscitation treatment and cured. Four cases died after damage control operation due to multiple organ failure and the mortality was 21.1%.

CONCLUSIONApplication of DCS approach can improve the prognosis of patients with severe pancreaticoduodenal injuries.

Adult ; Duodenum ; injuries ; surgery ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; injuries ; surgery ; Pancreaticoduodenectomy ; Retrospective Studies ; Young Adult

The aim of this study was to identify factors that predict morbidity and mortality in patients with traumatic pancreatic injuries. A retrospective review was performed on 75 consecutive patients with traumatic pancreatic injuries admitted to the Emergency Medical Center at Masan Samsung Hospital and subsequently underwent laparotomy during the period January 2000 to December 2005. Overall mortality and morbidity rates were 13.3% and 49.3%, respectively. A multivariate regression analysis revealed that greater than 12 blood transfusions and an initial base deficit of less than -11 mM/L were the most important predictors of mortality (p<0.05). On the other hand, the most important predictors of morbidity were surgical complexity and an initial base deficit of less than -5.8 mM/L (p<0.01). These data suggests that early efforts to prevent shock and rapidly control of bleeding are most likely to improve the outcome in patients with traumatic pancreatic injuries. The severity of pancreatic injury per se influenced only morbidity.
Adult ; Blood Transfusion ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Pancreas/*injuries/surgery ; Prognosis ; Retrospective Studies ; Wounds and Injuries/mortality

OBJECTIVETo present a batch of data of transected pancreatic neck injuries and to sum up the experience in surgical interventions for the injuries.

METHODSWe analysed 13 patients with a transected injury to the pancreatic neck from Jan. 1995 to Dec. 2000. External drainage was performed in all patients. Pancreatoduodenectomy was conducted in 2 patients with a transected injury to the pancreatic neck associated with duodenal ruptures, and TPN was administered immediately after operation. Proximal closure of the transected margin and distal pancreaticojejunostomy was performed in 4 patients. Proximal closure of the transected margin and distal pancreaticojejunostomy plus splenectomy was performed in 7 patients associated with contusion of pancreatic body or tail plus spleen rupture.

RESULTS12 patients healed and one patient died of anesthetic accident during the course of restoration of the dislocation of his right hip joint. Complications occurred in 7 patients.

CONCLUSIONSThe operation should be performed according to the degree of the injuries and associated duodenal injuries. Routine drainage and nutrient support should be recommended.

Adolescent ; Adult ; Child ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Nutritional Support ; Pancreas ; injuries ; surgery

In order to summarize the clinical diagnosis and treatment methods for 42 cases of multiple injuries with pancreatic injury, a retrospective analysis on 42 cases of multiple injuries with pancreatic injury from January 1990 to January 2006 was carried out in our hospital. Most cases were associated with hemopneumothorax and rib fractures (52.3%), shock (50%), multiple fractures (47.6%), and severe brain injury (26.1%). In 42 cases, one case died of severe hemorrhagic shock, and the remaining 41 cases (97.6%) were cured (including 40 cases receiving surgical operation and one case receiving the conservative treatment). Postoperative complications occurred in 16 cases (21 cases/times): pancreatic fistula (5 cases/times) and incisional wound infection (5 cases/times), intra-abdominal infection (3 cases/times), stress ulcer (3 cases/times), pleural effusion (3 cases/times), pulmonary infection (one case) and wound dehiscence (1 case). The principle therapy of multiple injuries with pancreatic injury is to rescue life, followed by active treatment to prevent injuries which giving rise to the abnormal respiratory and circulatory functions, management of cerebral hernia and other injuries which endangers life at last, and the pancreatic injury to increase the survival rate and survival quality.
Abdominal Injuries/*diagnosis ; Abdominal Injuries/*therapy ; Accidents, Traffic ; Emergency Medicine/methods ; Multiple Trauma ; Pancreas/*injuries ; Retrospective Studies ; Treatment Outcome ; Wound Healing ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/therapy

Conflicting results have been reported, as to whether or not wound repair is influenced following treatment with low doses of prednisolone, insulin, or thyrotrophic hormone. The present studies were undertaken to evaluate and compare the influence of above hormones on the wound repair process and their target organs in rats at different times after operation. The influence of the above hormones were observed as measurement of the tensile strength of healing skin incisions and the histologic finding of the wound sites and the target organs staining with H-E, PAS, and Masson's trichrome method. Saline 0. 1 ml were injected daily intramusculary in control group: prednisolone acetate 0. 2ml (4mg/kg/day) in prednisolone treated group: regular zinc insulin 0.1 ml(1.5IU/kg/day) in insulin treated group; thyrotrophin 0.1 ml (0.4IU/kg/day) in TSH trcated group. The observation period wer at 4th day, 7th day, 14th day and 21st day of post-operation. The results were as follows: 1. Prednisolone treated group: (1) The tensile strength were decreased at 4th and 7th day than control groups, but there were no statistically significant difference at 14th and 21st day from control group. (2) In histologic findings of the wound sites at 4th and 7th day, the repair processes were suppressed, but at 14th and 21st day, there were no difference from control group. (3) In histologic finding of adrenal cortex, the atrophic changes was observed from early stage. 2. Insulin treated group: (1) There were no statistical difference from control group in tensile strength at each observation period. (2) In histologic findings of the wound sites, the pictures of the repair processes were similar with control group at each observation period. (3) Atrophic change of islets of Langerhans in pancreas was observed at each observation period. 3. TSH treated group: (1) The tensile strength were increased at 4th, 7th, and 14th day than control group, but there was no statistical difference at 21st day frorn control group. (2) In histologic findings of the wound sites, the repair processes were aecelerated at 4th and 7th day than control group, but there were no defferences at 14th and 21st day from control group. (3) Hyperplastic change of acini in thyroid gland was observed through entire observation period.
Adrenal Cortex ; Animals ; Insulin ; Islets of Langerhans ; Pancreas ; Prednisolone ; Rats ; Skin ; Tensile Strength ; Thyroid Gland ; Thyrotrophs ; Thyrotropin ; Wounds and Injuries* ; Zinc

OBJECTIVETo summarize the management of pancreatic injuries after blunt abdominal trauma.

METHODSThe clinical data of 42 patients with blunt pancreatic injury admitted from January 2001 to December 2010 was analyzed retrospectively. There were 38 male and 4 female patients, aging from 13 to 65 years with a mean of 31 years. The organ injury scaling of Committee of the American Association for the Surgery of Trauma (AAST grade): grade I in 3 patients, grade II in 12 patients, grade III in 9 patients, grade IV in 13 patients and grade V in 5 patients. The mean injury severity score was 27 ± 21. Patients above AAST grade II underwent peritoneal drainage and "three neostomy" (gastrostomy, jejunostomy and gallbladder) according to damage control theory.

RESULTSThirty-eight patients got abdominal CT scanning with a positive rate of 79.9% (30/38). Forty patients underwent surgical procedures, and 2 patients with non-operative management. The surgical procedures include peritoneal drainage and "three neostomy" in 32 patients, pancreas suture or pancreatic tail resection in 6 patients, pancreatoduodenectomy or caudal pancreaticojejunostomy in 2 patients. Forty patients (95.2%) survived, 2 patients (4.8%) died and 16 patients (38.1%) had complications such as pancreatic fistula,pulmonary infection.

CONCLUSIONSAbdominal CT scanning will benefit the preoperative diagnosis of blunt pancreatic trauma. Although the survival rate of patients with blunt pancreatic trauma might be improved by using the damage control surgery, the management of damage control surgery also needs to be modified because of the high rate of complications.

Adolescent ; Adult ; Aged ; Drainage ; Female ; Humans ; Male ; Middle Aged ; Pancreas ; injuries ; surgery ; Retrospective Studies ; Wounds, Nonpenetrating ; surgery ; Young Adult

PURPOSE: Hemorrhage following pancreatoduodenectomy is a severe, life-threatening complication. This study was conducted to suggest methods of the prevention and management of hemorrhagic complications. METHODS: We reviewed medical records of 456 patients who had undergone pancreatoduodenectomy at Seoul National University Hospital between January 1991 and December 2000. RESULTS: Postoperative bleeding occurred in 21 patients. Early hemorrhage within the postoperative 5th day amounted 5 cases, which were caused by improper intra-operative hemostasis. Three of these patients were saved by prompt surgery and, in one patient, conservative management. Late hemorrhage after the postoperative 5th day included 16 cases, of which 12 patients (75%) were associated with pancreas anastomotic leaks and 8 patients displayed pseudoaneurysm. "Sentinel bleeding" was evident in 8 cases. Angiographic embolization was performed in 8 cases, achieving hemostasis in 7 cases. Reoperations were attempted in 7 cases with complete hemostasis in 2 cases. As a result, 15 of 21 patients obtained complete hemostasis and mortality rate from postoperative hemorrhage was 28.6% (6/21). CONCLUSION: Successful hemostasis was achieved by surgery in case of early hemorrhage and by angiographic embolization in late hemorrhage. In order to prevent hemorrhage following pancreatoduodenectomy, meticulous hemostasis and considerate operative techniques for avoiding pancreatic anastomotic leaks or vascular injury are essential.
Anastomotic Leak ; Aneurysm, False ; Hemorrhage* ; Hemostasis ; Humans ; Medical Records ; Mortality ; Pancreas ; Pancreaticoduodenectomy* ; Postoperative Hemorrhage ; Seoul ; Vascular System Injuries

Aneurysm of gastroduodenal artery (GDA) is rare. Most reported cases are due to pancreatitis and atherosclerosis; however, those following pancreatic trauma have not been reported. We encoun- tered GDA aneurysm in a patient of blunt abdominal trauma, who had pancreatic contusion and retroduodenal air on contrast enhanced computed tomography of abdomen. Emergency laparotomy for suspected duodenal injury revealed duodenal wall and pancreatic head contusion, mild hemo- peritoneum and no evidence of duodenal perforation. In the postoperative period, the patient developed upper gastrointestinal hemorrhage on day 5. Repeat imaging revealed GDA aneurysm, which was managed successfully by angioembolization. This case highlights, one, delayed presen- tation of GDA aneurysm after blunt pancreatic trauma and two, its successful management using endovascular technique.
Abdominal Injuries ; complications ; Adult ; Aneurysm ; etiology ; Duodenum ; blood supply ; Embolization, Therapeutic ; Humans ; Male ; Pancreas ; injuries ; Stomach ; blood supply ; Wounds, Nonpenetrating ; complications