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Phelan HA, Minei JP. Pancreatic trauma: diagnostic and therapeutic strategies. Curr Treat Options Gastroenterol. 2005;8(5):355-63doi: 10.1007/s11938-005-0038-4.
Phelan, H. A., & Minei, J. P. (2005). Pancreatic trauma: diagnostic and therapeutic strategies. Current treatment options in gastroenterology, 8(5), 355-63. https://doi.org/10.1007/s11938-005-0038-4
Phelan, Herb A, and Minei, Joseph P. "Pancreatic trauma: diagnostic and therapeutic strategies." Current treatment options in gastroenterology vol. 8,5 (2005): 355-63. doi: https://doi.org/10.1007/s11938-005-0038-4
Phelan HA, Minei JP. Pancreatic trauma: diagnostic and therapeutic strategies. Curr Treat Options Gastroenterol. 2005 Oct;8(5):355-63. doi: 10.1007/s11938-005-0038-4. PMID: 16162301.
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Curr Treat Options Gastroenterol. 2005 Oct;8(5):355-63. doi: 10.1007/s11938-005-0038-4.

Pancreatic trauma: diagnostic and therapeutic strategies.

Current treatment options in gastroenterology

Herb A Phelan, Joseph P Minei

Affiliations

  1. Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.

PMID: 16162301 DOI: 10.1007/s11938-005-0038-4

Abstract

The management of pancreatic trauma provides trauma surgeons with diagnostic and therapeutic challenges. The two most important facts that must be established are the location of the injury in relation to the superior mesenteric artery and vein and the status of the main pancreatic duct. If a pancreatic injury is discovered at the time of exploration and no main ductal injury is found, debridement and wide drainage are adequate therapy regardless of the location of the injury. If the status of the duct cannot be confidently determined and the injury lies to the left of the vessels, a single attempt at cholecystocholangiography should be performed. If this is unsuccessful, distal pancreatectomy with splenectomy with no further attempts at ductal imaging are our treatments of choice. Splenic salvage may be considered in the pediatric population. If the injury lies to the right of the vessels and the status of the duct is not able to be diagnosed with thorough exploration, we recommend endoscopic retrograde cholangiopancreatography (ERCP), either intraoperatively or on an urgent basis postoperatively, with wide closed suction drainage prior to closure of the abdomen. If the ERCP shows intact pancreatic and common bile ducts, expectant management is warranted. If the duct is injured, the patient is returned to the operating room for debridement of the injury, oversewing of the proximal pancreatic duct, and a distal pancreaticojejunostomy. Use of ERCP to stent this injury type has been reported but has yet to be rigorously studied. If the ampulla is destroyed or the pancreatic head is devascularized, pancreaticoduodenectomy is required either at the original surgery or after patient stabilization if damage control laparotomy is necessary. If a stable trauma patient has findings on a computed tomography suggestive of an isolated pancreatic injury, we still recommend laparotomy using the previously mentioned algorithm. All patients with pancreatic injury should have feeding access placed intraoperatively beyond the ligament of Treitz, with our choice being a nasal-jejunal feeding tube. Postoperative pancreatic fistulae should be managed with adequate closed suction drainage, octreotide, and observation for a period of at least 4 to 8 weeks prior to contemplation of surgical intervention.

References

  1. J Trauma. 2002 Oct;53(4):780-3 - PubMed
  2. Ann Surg. 1997 Jul;226(1):70-6 - PubMed
  3. J Trauma. 1989 Oct;29(10):1352-5 - PubMed
  4. J Am Coll Surg. 2003 Jun;196(6):954-64 - PubMed
  5. Am Surg. 1996 Jun;62(6):446-8 - PubMed
  6. J Trauma. 1996 Jul;41(1):143-4 - PubMed
  7. Br J Radiol. 1998 Sep;71(849):985-90 - PubMed
  8. J Trauma. 1990 Nov;30(11):1427-9 - PubMed
  9. South Med J. 2000 Apr;93(4):383-5 - PubMed
  10. Surg Gynecol Obstet. 1986 Nov;163(5):428-32 - PubMed
  11. Arch Surg. 1971 Apr;102(4):424-30 - PubMed
  12. Ann Surg. 1998 Jun;227(6):861-9 - PubMed
  13. Curr Probl Surg. 1999 May;36(5):325-419 - PubMed
  14. J Trauma. 1999 Sep;47(3):585-7 - PubMed
  15. Postgrad Med J. 1995 Feb;71(832):116-7 - PubMed
  16. J Trauma. 1991 May;31(5):661-7; discussion 667-8 - PubMed
  17. J Trauma. 1997 Aug;43(2):234-9; discussion 239-41 - PubMed
  18. J Trauma. 1994 Sep;37(3):395-400 - PubMed
  19. South Med J. 1989 May;82(5):586-91 - PubMed
  20. Br J Surg. 2001 Feb;88(2):190-9 - PubMed
  21. Am Surg. 1999 Aug;65(8):777-83 - PubMed
  22. J Gastrointest Surg. 2000 Jul-Aug;4(4):366-9 - PubMed
  23. Gastrointest Endosc. 1996 Dec;44(6):723-5 - PubMed
  24. Hepatogastroenterology. 2003 Jan-Feb;50(49):269-71 - PubMed
  25. J Am Coll Surg. 2003 Dec;197(6):937-42 - PubMed
  26. Am J Surg. 1994 Oct;168(4):345-7 - PubMed
  27. Surg Gynecol Obstet. 1978 Jun;146(6):959-62 - PubMed
  28. Surg Clin North Am. 1996 Oct;76(5):1159-73 - PubMed
  29. Gastrointest Endosc. 2001 Jul;54(1):49-55 - PubMed
  30. Am J Surg. 1997 Jul;174(1):54-60 - PubMed
  31. J Trauma. 1996 Feb;40(2):253-7 - PubMed

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