Advertisement

Journal of Hepato-Biliary-Pancreatic Sciences

, Volume 18, Issue 2, pp 195–201 | Cite as

Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?

  • Nicola Antonacci
  • Salomone Di SaverioEmail author
  • Valentina Ciaroni
  • Andrea Biscardi
  • Aimone Giugni
  • Francesco Cancellieri
  • Carlo Coniglio
  • Piergiorgio Cavallo
  • Eleonora Giorgini
  • Franco Baldoni
  • Giovanni Gordini
  • Gregorio Tugnoli
Original article

Abstract

Background/purpose

Abdominal trauma rarely causes injuries involving the duodenum and pancreas. Associated injuries occur in 46% of all pancreatic injuries. The morbidity and mortality of pancreaticoduodenal injuries remain high.

Methods

The present study is a retrospective review of our experience from 1989 to 2008 in the surgical treatment of traumatic pancreaticoduodenal injuries. Mortality, morbidity, prognostic factors, and the value of surgical techniques were analyzed.

Results

In our level I Trauma Center, between 1989 and 2008, 55 patients had a pancreaticoduodenal injury. In 68.5% of cases pancreatic injuries were found, 20.4% had duodenal injury, and 11.1% suffered combined pancreaticoduodenal injuries; 85.3% of the patients had blunt abdominal trauma, while 14.9% had penetrating injuries. We treated 78.1% of the patients with external drainage and/or simple suture; distal pancreatectomy was performed in 9% of cases and duodenal resection with anastomosis (3.7%) and diversion procedures (3.7%) were performed in an equal number of patients. Age, American Association for the Surgery of Trauma (AAST) grade, organ involved, hemodynamic status, intraoperative cardiac arrest, and operative time remained strongly predictive of mortality on multivariate analysis. The AAST grade represented, on multivariate analysis, the only independent prognostic factor predictive of overall morbidity. In the past decade we have used feeding jejunostomy more frequently, with a reduction of mortality and operating time, due also to a better approach from a dedicated trauma team.

Conclusions

Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures.

Keywords

Pancreatic trauma Duodenal trauma Damage control surgery Pancreatectomy Feeding jejunostomy Trauma intensive care 

References

  1. 1.
    Asensio JA, Demetriades D, Hanpeter D, Gambaro E, Chahwan S. Management of pancreatic injuries. In: Wells SA Jr, editor. Current problems in surgery. Vol. XXXVI, No 5. St. Louis: Mosby-Yearbook; 1999. p. 325–420.Google Scholar
  2. 2.
    Asensio JA, Stewart BM, Demetriades D. Penetrating injuries to the duodenum. In: Ivatury RR, Cayten CG, editors. Textbook of penetrating trauma. Chap. 49. Philadelphia: Lea & Febiger; 1995, p. 610–30.Google Scholar
  3. 3.
    Lucas C, Ledgerwood A. Factors influencing outcome after blunt duodenal trauma. J Trauma. 1975;15:839–44.PubMedCrossRefGoogle Scholar
  4. 4.
    Lin BC, Chen RJ, Fang JF, et al. Management of blunt major pancreatic injuries. J Trauma. 2004;56:774–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Wolf A, Bernhardt J, Patrzyk M, Heidecke CD. The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc. 2005;19:665–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Cogbill TH, Moore E, Feliciano DV, et al. Conservative management of duodenal trauma: a multicenter experience. J Trauma. 1990;30:1469–75.PubMedCrossRefGoogle Scholar
  7. 7.
    Kashuk JL, Burch JM. Duodenum and pancreas. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th edn. New York: McGraw-Hill; 2008.Google Scholar
  8. 8.
    Cogbil TH, Moore EE, Morris JA, et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma. 1991;31:1600–6.CrossRefGoogle Scholar
  9. 9.
    Lopez PP, Benjamin R, Cockburn M, et al. Recent trends in the management of combined pancreatoduodenal injuries. Am Surg. 2005;71:847–52.PubMedGoogle Scholar
  10. 10.
    Bradley ELY, Young PR Jr, Chang M, et al. Diagnosis and initial management of blunt pancreatic trauma Guidelines from a multi-istitutional review. Ann Surg. 1998;227:861–9.PubMedCrossRefGoogle Scholar
  11. 11.
    Itahi O, Bochicchio GV, Scalea TM. Efficacy of computer tomography in the diagnosis of pancreatic injuiry in adult blunt trauma patients: a single instituional study. Am Surg. 2002;68:704–7.Google Scholar
  12. 12.
    Buccimazza I, Thomson SR, Anderson F, et al. Isolated main pancreatic duct injuries spectrum and management. Am J Surg. 2006;191:448–52.PubMedCrossRefGoogle Scholar
  13. 13.
    Huerta S, Bui T, Porral D, et al. Predictors of morbidity and mortality in patients with traumatic duodenal injuries. Am Surg. 2005;71:763–7.PubMedGoogle Scholar
  14. 14.
    Tyburski JG, Dente CH, Wilson RF, et al. Pancreatic and duodenal injuries: complex and lethal. Scand J Surg. 2002;91:81–6.Google Scholar
  15. 15.
    Velmahos GC, Costantinou C, Kasatakis G. Safety of repair for severe duodenal injuries. World J Surg. 2008;32:7–12.PubMedCrossRefGoogle Scholar
  16. 16.
    Asensio JA, Petrone P, Roldan G, et al. Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries. J Am Coll Surg. 2003;197(6):937–42.PubMedCrossRefGoogle Scholar
  17. 17.
    Duchesse JC, Schmieg R, Islam S, et al. Selective nonoperative management of low grade blunt pancreatic injury. J Trauma. 2008;65:40–53.Google Scholar

Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2010

Authors and Affiliations

  • Nicola Antonacci
    • 1
    • 2
  • Salomone Di Saverio
    • 1
    • 2
    Email author
  • Valentina Ciaroni
    • 1
    • 2
  • Andrea Biscardi
    • 1
    • 2
  • Aimone Giugni
    • 3
  • Francesco Cancellieri
    • 3
  • Carlo Coniglio
    • 3
  • Piergiorgio Cavallo
    • 3
  • Eleonora Giorgini
    • 1
    • 2
  • Franco Baldoni
    • 1
    • 2
  • Giovanni Gordini
    • 3
  • Gregorio Tugnoli
    • 1
    • 2
  1. 1.Department of Emergency, Emergency Surgery and Trauma Surgery UnitMaggiore HospitalBolognaItaly
  2. 2.Department of Surgery, Emergency Surgery and Trauma Surgery UnitMaggiore HospitalBolognaItaly
  3. 3.Department of Emergency, Trauma ICU, Trauma CenterMaggiore HospitalBolognaItaly

Personalised recommendations