COMPLEX PANCREATIC INJURIES - 11/09/11
Résumé |
Pancreatic injuries continue to challenge those caring for traumatized patients. Owing to the retroperitoneal location of the pancreas and its proximity to major vascular structures, associated injuries play a significant role in morbidity and mortality. In the past, considerable controversy existed over the proper management of pancreatic wounds. In regard to minor injuries, this debate has recently diminished somewhat thanks to a number of clinical reviews that have served to standardize management protocols for such injuries.5, 16, 20 Despite some degree of ideologic unity, clinicians are still often faced with diagnostic and technical dilemmas when dealing with the more complex pancreatic injuries. Yet, by establishing an early and accurate diagnosis and by judicious yet adequate management, acceptable morbidity and mortality can be obtained in most settings.
Pancreatic injuries comprise approximately 12% of the injuries to victims of abdominal trauma.12, 16 Two thirds of these injuries are penetrating in nature.12, 15, 33 Blunt injuries, although less common, often present diagnostic challenges due in part to the retroperitoneal location of the organ and the nondescript early clinical signs and symptoms of injury.
It appears that an important factor contributing to morbidity is failure of proper recognition of a main pancreatic ductal injury. This determination also often dictates operative management and thereby must be done early so that appropriate but not overzealous management can proceed expeditiously. The methods used to definitely determine the presence or absence of ductal injury remain controversial, although once the proper determination has been made management techniques are fairly standardized. Management in recent years has shifted to reflect a conservative approach; that is, resective therapy is used judiciously, pancreaticoenteric anastomosis has been all but abandoned, and external drainage is the mainstay of therapy.9
Mortality in victims of pancreatic trauma ranges from 12% to 30% and is often determined by associated injuries and occurs early in the clinical course, most frequently as a result of penetrating trauma. Late deaths usually result from uncontrolled pancreatic sepsis precipitated by inappropriate initial management or delayed management of complications. Major morbidity can usually be related to the presence of pancreatic ductal injury or associated duodenal injury.39 Overzealous resection and inappropriate pancreaticoenteric anastomoses are preventable causes of morbidity which can often be avoided by adherence to strict management guidelines.
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| Address reprint requests to Timothy C. Fabian, MD, Department of Surgery, University of Tennessee, 956 Court Avenue, Suite G210, Memphis, TN 38163 |
Vol 76 - N° 4
P. 783-795 - août 1996 Retour au numéro
Article précédent
- COMPLEX HEPATIC INJURIES
- H. Leon Pachter, David V. Feliciano
- COMPLEX DUODENAL INJURIES
- Rao R. Ivatury, Zahi E. Nassoura, Ronald J. Simon, Aurelio Rodriguez
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