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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
Article

Abstract

Background

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

Methods

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.

Results

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%.

Conclusion

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.

Keywords

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

Notes

Acknowledgements

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

Compliance with ethical standards

Disclosures

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.

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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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