Skip to main content

Advertisement

SpringerLink
Log in

Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

The relevance of pancreatic trauma in severely injured patients within a large collective has not been thoroughly analyzed yet. This study aimed at assessing the prevalence of pancreatic trauma in relation to the outcome and the currently established algorithm of treatment.

Methods

Some 51,425 patients from the Trauma Register of the German Society of Trauma Surgery (TR DGU) (1993–2009) were retrospectively analyzed. All patients with an “injury severity score” ≥16, direct admission to a trauma center and subsequent treatment for at least 3 days, age ≥16, and an abdominal injury [abbreviated injury scale (AIS)abdomen ≥2] were included. Patients with abdominal trauma (AISabdomen ≥2) were compared with patients with an additional pancreatic trauma (AISpancreas 2–5).

Results

Of 51,425 patients, 9,268 (18%) had documented abdominal injuries. Two hundred eighty-four (3.1%) patients with abdominal injury additionally showed a pancreatic injury (AISabdomen ≥2, AISpancreas 2–5) and were analyzed in dependency of the classification of the American Association for the Surgery of Trauma (AAST) organ severity score. AAST–pancreas: II°, 1.9%; III°, 0.6%; IV°, 0.3%; and V°, 0.2%. Patients with leading pancreatic injury (grades IV and V) thereby showed a significant increase of mortality (IV°, 30.0% and V°, 33.3%) and an increase of the need for surgical intervention (IV°, 80.6% and V°: 81.8%).

Conclusions

The results presented here show the prevalence and the outcome of pancreas injury in a large collective within the TR DGU for the first time. Based on the current literature and the findings, a treatment algorithm has been developed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Tan KK, Chan DX, Vijayan A, Chiu MT (2009) Management of pancreatic injuries after blunt abdominal trauma. Experience at a single institution. J Pancreas 10:657–663

    Google Scholar 

  2. Carboni GL, Roethlin MA, Trentz O (1999) Verfahrenswahl in der Behandlung von Pankreasverletzungen. Unfallchirurg 102:298–304

    Article  PubMed  CAS  Google Scholar 

  3. Bouillon B, Kanz KG, Lackner CK, Mutschler W, Sturm J (2004) The importance of Advanced Trauma Life Support (ATLS) in the emergency room. Unfallchirurg 107:844–850

    Article  PubMed  CAS  Google Scholar 

  4. Patton J, Fabian T (1996) Complex pancreatic injuries. Surg Clin North Am 76:783–796

    Article  PubMed  Google Scholar 

  5. Rigon R, Trevisan P, Giacomazzi A (1994) Pancreatic trauma: a rare but severe event. Minerva Chir 49:509–514

    PubMed  CAS  Google Scholar 

  6. Jurkovich GJ, Carrico CJ (1990) Pancreatic trauma. Surg Clin North Am 70:575–593

    PubMed  CAS  Google Scholar 

  7. Pfitzenmaier J, Buse S, Haferkamp A, Pahernik S, Djakovic N, Hohenfellner M (2009) Nierentrauma. Unfallchirurg 112:317–326

    Article  PubMed  CAS  Google Scholar 

  8. Wisner DH, Wold RL, Frey CF (1990) Diagnosis and treatment of pancreatic injuries. An analysis of management principles. Arch Surg 125:1109–1113

    PubMed  CAS  Google Scholar 

  9. Wilson RH, Moorehead RJ (1991) Current management of trauma to the pancreas. Br J Surg 78:1196–1202

    Article  PubMed  CAS  Google Scholar 

  10. Flohé S, Nast-Kolb D (2009) Surgical management of life-threatening injuries. Unfallchirurg 112:854–859

    Article  PubMed  Google Scholar 

  11. Woelfl CG, Gliwitzky B, Wentzensen A (2009) Standardised primary care of multiple trauma patients: Prehospital Trauma Life Support und Advanced Trauma Life Support. Unfallchirurg 112:846–853

    Article  Google Scholar 

  12. Ruchholtz S (2000) The trauma registry of the German society of trauma surgery as a basis for interclinical quality management. A multicenter study of the German society of trauma surgery. Unfallchirurg 103:30–37

    Article  PubMed  CAS  Google Scholar 

  13. Osler T, Baker SP, Long W (1997) A modification of the injury severity score that both improved accuracy and simplifies scoring. J Trauma 43:922–926

    Article  PubMed  CAS  Google Scholar 

  14. Bone RC, Balk RA, Cerra FB (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest 101:1644–1655

    Article  PubMed  CAS  Google Scholar 

  15. Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 22:707–710

    Article  PubMed  CAS  Google Scholar 

  16. Huber-Wagner S, Lefering R, Qvick LM et al (2009) Effect of whole-body CT during trauma resuscitation on survival: a retrospective, multicentre study. Lancet 373:1455–1461

    Article  PubMed  Google Scholar 

  17. Dutton RP, Lefering R, Lynn M (2006) Database predictors of transfusion and mortality. J Trauma 60:70–77

    Article  Google Scholar 

  18. Ruchholtz S, Lefering R, Paffrath T et al (2008) Reduction in mortality of severely injured patients in Germany. Dtsch Arztebl Int 105:225–231

    PubMed  Google Scholar 

  19. Lefering R (2009) Development and validation of the Revised Injury Severity Classification (RISC) score for severely injured patients. Eur J Trauma Emer Surg 35:437–447

    Article  Google Scholar 

  20. Lendemans S, Heuer M, Nast-Kolb D et al (2008) Significance of liver trauma for the incidence of sepsis, multiple organ failure and lethality of severely injured patients. An organ-specific evaluation of 24,771 patients from the trauma register of the DGU. Unfallchirurg 111:232–239

    Article  PubMed  CAS  Google Scholar 

  21. Malone D, Napolitano LM, Genuit T et al (2001) Total cytokine immunoassay: a more accurate method of cytokine measurement? J Trauma 50:821–825

    Article  PubMed  CAS  Google Scholar 

  22. Moore FA, Moore EE, Sauaia A (1997) Blood transfuision. An independent risk factor for postinjury multiple organ failure. Arch Surg 132:620–624

    PubMed  CAS  Google Scholar 

  23. Croce MA, Fabian TC, Menke PG et al (1995) Nonoperative management of blunt hepatic trauma is the treatment of choice for hemodynamically stable patients. Results of a prospective trail. Ann Surg 221:744–753

    Article  PubMed  CAS  Google Scholar 

  24. Regel G, Lobenhoffer P, Lehmann U, Pape HC, Pohlemann T, Tscherne H (1993) Results of treatment of polytraumatized patients. A comparative analysis of 3,406 cases between 1972 and 1991. Unfallchirurg 96:350–362

    PubMed  CAS  Google Scholar 

  25. Malgras B, Douard R, Siauve N, Wind P (2011) Management of left pancreatic trauma. Am Surg 77:1–9

    PubMed  Google Scholar 

  26. Ahmed N, Vernick JJ (2009) Pancreatic injury. South Med J 102:1253–1256

    Article  PubMed  Google Scholar 

  27. Clarke JR, Trooskin SZ, Doshi PJ et al (2002) Surgical management, prognostic factors, and outcome in hepatic trauma. J Trauma 52:420–425

    Article  PubMed  Google Scholar 

  28. Schroeppel TJ, Croce MA (2007) Diagnosis and management of blunt abdominal solid organ injury. Curr Opin Crit Care 13:399–404

    Article  PubMed  Google Scholar 

  29. Wutzler S, Westhoff J, Lefering R et al (2010) Zeitintervalle während und nach Schockraumraumversorgung. Eine Analyse anhand des Traumaregisters der Deutschen Gesellschaft für Unfallchirurgie (DGU). Unfallchirurg 113:36–43

    Article  PubMed  CAS  Google Scholar 

  30. The American Association for the Surgery of Trauma. http://www.aast.org. Accessed 18 January 2011

  31. Lefering R (2009) Development and validation of the revised injury severity classification score for severely injured patients. Eur J Trauma Emerg Surg 35:437–447

    Article  Google Scholar 

Download references

Acknowledgments

Finally, we would like to thank the members of the Polytrauma Study Group of the German Society of Trauma Surgery (DGU) for the intensive work for many years on the trauma register. The Polytrauma Study Group has been integrated in the emergency, intensive care, and severe injury departments of the DGU since the beginning of 2008. The current clinics which provided data for this analysis to the trauma register may be found at www.traumaregister.de. We wish to expressly thank them for their cooperation.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122, Essen, NRW, Germany

    Matthias Heuer, Gernot M. Kaiser & Andreas Paul

  2. Department of Trauma Surgery, University Hospital of Essen, Hufelandstrasse 55, 45122, Essen, NRW, Germany

    Björn Hussmann, Georg Taeger & Sven Lendemans

  3. Institute for Research in Operative Medicine, Faculty of Medicine, University of Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, NRW, Germany

    Rolf Lefering

Authors
  1. Matthias Heuer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Björn Hussmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rolf Lefering
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Georg Taeger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gernot M. Kaiser
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andreas Paul
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sven Lendemans
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

The Trauma Registry of the DGU

Corresponding author

Correspondence to Sven Lendemans.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heuer, M., Hussmann, B., Lefering, R. et al. Pancreatic injury in 284 patients with severe abdominal trauma: outcome, course, and treatment algorithm. Langenbecks Arch Surg 396, 1067–1076 (2011). https://doi.org/10.1007/s00423-011-0836-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-011-0836-1

Keywords

Search

Navigation