Article ID: 25-008
Management of traumatic pancreatic injury is challenging, and mortality and morbidity remain high. Because pancreatic injury is uncommon and strong recommendations for pancreatic injury management are lacking, management is primarily based on institutional practices. We propose our strategy of pancreatic injury management. Methods We retrospectively reviewed all admissions for traumatic pancreatic injury and evaluated our strategy and patient outcomes. Results From January 2014 to January 2025, 20 patients were admitted with traumatic pancreatic injury. Median Injury Severity Score was 16(12-29) and probability of survival was 0.87(0.78-0.92). AAST injury grades were I (n=2; 11.1%), II (n=7; 33.3%), III (n=9; 44.4%), IV (n=2; 11.1%). All patients underwent endoscopic pancreatic ductal evaluation within 1-2 days after admission. Abbreviated surgery because of hemodynamic instability were performed for 4 patients with pancreas body/tail injury. Of the sixteen patients with stable hemodynamics and suspected pancreatic injury by CT scan, since the three patients showed signs of peritonitis, emergency laparotomy was performed prior to the evaluation of main pancreatic duct. Of those, one patient had been performed distal pancreatectomy and two patients had been performed laparotomy + closed suction drainage (CSD) management due to the pancreas head injuries. Afte ERCP was performed, one patient had been added endoscopic drainage (ED). Of the 11 patients who had been performed ERCP, nine were treated with ED only, two had distal pancreatectomy + CSD placement. The duration of ED and CSD placement was18 (9-24) days and 14 (6-32) days respectively, the length of hospitalization was 25 (9-33) days. Delayed formation of pancreatic pseudocysts was observed in 10% of the patients and no pancreatic injury associated death was observed. Conclusion Our uniform, simplified strategy offers good outcomes for any pancreatic injury site and any concomitant injuries even in hemodynamically unstable patients.
