Surgical Endoscopy

, Volume 31, Issue 10, pp 4201–4210 | Cite as

Major pancreatic duct continuity is the crucial determinant in the management of blunt pancreatic injury: a pancreatographic classification

  • Being-Chuan LinEmail author
  • Yon-Cheong Wong
  • Ray-Jade Chen
  • Nai-Jen Liu
  • Cheng-Hsien Wu
  • Tsann-Long Hwang
  • Yu-Pao Hsu



To evaluate the management and outcomes of blunt pancreatic injuries based on the integrity of the major pancreatic duct (MPD).


Between August 1996 and August 2015, 35 patients with blunt pancreatic injuries underwent endoscopic retrograde pancreatography (ERP). Medical charts were retrospectively reviewed for demography, ERP timing, imaging findings, management, and outcome.


Of the 35 patients, 21 were men and 14 were women, with ages ranging from 11 to 70 years. On the basis of the ERP findings, we propose a MPD injury classification as follows: class 1 indicates normal MPD; class 2, partial injury with intact MPD continuity; and class 3, complete injury with disrupted MPD continuity. Both classes 2 and 3 are subdivided into classes a, b, and c, which represent the pancreatic tail, body, and head, respectively. In this report, 14 cases belonged to class 1, 10 belonged to class 2, and 11 belonged to class 3. Of the 14 patients with class 1 injuries, 10 underwent nonsurgical treatment and 4 underwent pancreatic duct stenting. Of the 10 patients with class 2 injuries, 4 underwent nonsurgical treatment and 6 underwent pancreatic duct stenting. Two of the 11 patients with class 3 injuries underwent pancreatic duct stenting; one in the acute stage developed sepsis that led to death even after converting to distal pancreatectomy plus splenectomy. Of the 11 patients with class 3 injuries, spleen-preserving distal pancreatectomy was performed in 6, distal pancreatectomy plus splenectomy in 2, and Roux-en-Y pancreaticojejunostomy after central pancreatectomy in 2. The overall pancreatic-related morbidity rate was 60% and the mortality rate was 2.8%.


Based on our experience, class 1 and 2 injuries could be treated by nonsurgical means and pancreatic duct stenting could be an adjunctive therapy in class 2b and 2c injuries. Operation is warranted in class 3 injuries.


Endoscopic retrograde pancreatography Blunt pancreatic injury Major pancreatic duct continuity Pancreatic duct stenting Pancreatectomy 



The authors thank Miss Shu-Fang Huang for her statistical assistance.

Compliance with ethical standards


Drs Being-Chuan Lin, Yon-Cheong Wong, Ray-Jade Chen, Nai-Jen Liu, Cheng-Hsien Wu, Tsann-Long Hwang, and Yu-Pao Hsu have no conflicts of interest or financial ties to disclose.


  1. 1.
    Jurkovich GJ, Carrico CJ (1990) Pancreatic trauma. Surg Clin North Am 70:575–593CrossRefPubMedGoogle Scholar
  2. 2.
    Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL (2004) Management of blunt major pancreatic injury. J Trauma 56:774–778CrossRefPubMedGoogle Scholar
  3. 3.
    Moore EE, Cogbill T, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, McAninch JW, Pachter HL, Shackford SR, Trafton PG (1990) Organ injury scale II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma 30:1427–1429CrossRefPubMedGoogle Scholar
  4. 4.
    Wisner DH, Wold RL, Frey CF (1990) Diagnosis and treatment of pancreatic injuries: an analysis of management principles. Arch Surg 125:1109–1113CrossRefPubMedGoogle Scholar
  5. 5.
    Patton JH Jr, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, Fabian TC (1997) Pancreatic trauma: a simplified management guideline. J Trauma 43:234–241CrossRefPubMedGoogle Scholar
  6. 6.
    Biffl WL, Moore EE, Croce M, Davis JW, Coimbra R, Karmy-Jones R, McIntyre RC Jr, Moore FA, Sperry J, Malhotra A, Feliciano D (2013) Western Trauma Association critical decisions in trauma: management of pancreatic injuries. J Trauma Acute Care Surg 75:941–946CrossRefPubMedGoogle Scholar
  7. 7.
    Wong YC, Wang LJ, Fang JF, Lin BC, Ng CJ, Chen RJ (2008) Multidetector-row computed tomography (CT) of blunt pancreatic injuries: can contrast-enhanced multiphasic CT detect pancreatic duct injuries? J Trauma 64:666–672CrossRefPubMedGoogle Scholar
  8. 8.
    Belohlavek D, Merkle P, Probst M (1978) Identification of traumatic rupture of the pancreatic duct by endoscopic retrograde pancreatography. Gastrointest Endosc 24:255–256CrossRefPubMedGoogle Scholar
  9. 9.
    Barkin JS, Ferstenburg RM, Panullo W, Manten HD, Davis RC Jr (1988) Endoscopic retrograde cholangiopancreatography in pancreatic trauma. Gastrointest Endosc 34:102–105CrossRefPubMedGoogle Scholar
  10. 10.
    Bhasin DK, Rana SS, Rao C, Gupta R, Verma GR, Kang M, Nagi B, Singh K (2012) Endoscopic management of pancreatic injury due to abdominal trauma. J Pancreas 13:187–192Google Scholar
  11. 11.
    Takishima T, Hirata M, Kataoka Y, Asari Y, Sato K, Ohwada T, Kakita A (2000) Pancreatographic classification of pancreatic ductal injuries caused by blunt injury to the pancreas. J Trauma 48:745–752CrossRefPubMedGoogle Scholar
  12. 12.
    Thomson DA, Krige JE, Thomson SR, Bornman PC (2014) The role of endoscopic retrograde pancreatography in pancreatic trauma: a critical appraisal of 48 patients treated at a tertiary institution. J Trauma Acute Care Surg 76:1362–1366CrossRefPubMedGoogle Scholar
  13. 13.
    Kim HS, Lee DK, Kim IW, Baik SK, Kwon SO, Park JW, Cho NC, Rhoe BS (2001) The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc 54:49–55CrossRefPubMedGoogle Scholar
  14. 14.
    Whittwell AE, Gomez GA, Byers P, Kreis DJ Jr, Manten H, Casillas VJ (1989) Blunt pancreatic trauma: prospective evaluation of early endoscopic retrograde pancreatography. South Med 82:586–591CrossRefGoogle Scholar
  15. 15.
    Delcenserie R, Barthet MA, Yzet T, Grimaud JC, Dupas JL (2001) Endoscopic retrograde pancreatography in diagnosis and treatment of pancreatic trauma. Gastrointest Endosc 53:AB138Google Scholar
  16. 16.
    Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, Harrison P, Davenport M (2007) Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg 42:629–635CrossRefPubMedGoogle Scholar
  17. 17.
    Wind P, Tiret E, Cunningham C, Frileux P, Cugnenc P, Parc R (1999) Contribution of endoscopic retrograde pancreatography in management of complications following distal pancreatic trauma. Am Surg 65:777–783PubMedGoogle Scholar
  18. 18.
    Wood JH, Partrick DA, Bruny JL, Sauaia A, Moulton SL (2010) Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg 45:401–406CrossRefPubMedGoogle Scholar
  19. 19.
    Rogers SJ, Cello JP, Schecter WP (2010) Endoscopic retrograde cholangiography in patients with pancreatic trauma. J Trauma 68:538–544CrossRefPubMedGoogle Scholar
  20. 20.
    Keil R, Drabek J, Lochmannova J, Stovicek J, Rygl M, Snajdauf J, Hlava S (2016) What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children? Scand J Gastroenterol 51:218–224CrossRefPubMedGoogle Scholar
  21. 21.
    Coelho DE, Ardengh JC, Carbalo MT, de Lina-Filho ER, Baron TH, Coelho JF (2011) Clinicopathologic characteristics and endoscopic treatment of post-traumatic pancreatic pseudocysts. Pancreas 40:469–473CrossRefPubMedGoogle Scholar
  22. 22.
    Cheon YK, Cho KB, Watkins JL, Mchenry L, Fogel EL, Sherman S, Lehman GA (2007) “Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest Endosc 65:385–393CrossRefPubMedGoogle Scholar
  23. 23.
    Lin BC, Liu NJ, Fang JF, Kao YC (2006) Long-term results of endoscopic stent in the management of blunt major pancreatic duct injury. Surg Endosc 20:1551–1555CrossRefPubMedGoogle Scholar
  24. 24.
    Lin BC, Fang JF, Wong YC, Liu NJ (2007) Blunt pancreatic trauma and pseudocyst: management of major pancreatic duct injury. Injury 38:588–593CrossRefPubMedGoogle Scholar
  25. 25.
    Ikenberr SO, Sherman S, Hawes RH, Smith M, Lehman GA (1994) The occlusion rate of pancreatic stents. Gastrointest Endosc 40:611–613CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial HospitalChang Gung UniversityTao-Yuan CityTaiwan, ROC
  2. 2.Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial HospitalChang Gung UniversityTao-Yuan CityTaiwan, ROC
  3. 3.Department of SurgeryTaipei Medical University HospitalTaipeiTaiwan, ROC
  4. 4.Department of Gastroenterology, Chang Gung Memorial HospitalChang Gung UniversityTao-Yuan CityTaiwan, ROC
  5. 5.Department of General Surgery, Chang Gung Memorial HospitalChang Gung UniversityTao-Yuan CityTaiwan, ROC

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