Abstract
Background
Pancreatic stents can be used to treat a variety of acute and chronic pancreatic lesions. Sporadic successful trials in trauma patients have been reported. To our knowledge, however, a series with long-term follow-up has not previously been reported. We treated six patients in a 6-year period and report the long-term results.
Methods
From February 1999 to February 2005, six blunt-trauma patients with major pancreatic duct disruption were treated with pancreatic duct stent at a single trauma center. Assessment of injury severity and diagnosis were based on abdominal computed tomography (CT) and proved by endoscopic retrograde pancreatography (ERP), with chart review used to establish mechanism of injury, timing of ERP, and stent placement, as well as the long-term outcome.
Results
Three of the six injuries were classified AAST grade III and three were grade IV; the interval to ERP with stent placement ranged from 8 hours to 22 days after the injury. One patient developed sepsis and died. One patient’s stent could be removed early (52 days post-stenting) with mild ductal stricture, whereas the other four were complicated by severe ductal stricture that required repeated and prolonged stenting treatment. Removal of the stents was only possible in three of these four cases (at 12, 19, and 39 months, respectively), with stent dislodgment in the pancreatic duct occurring in another.
Conclusions
Stent therapy may avoid surgery in the acute trauma stage, and may be preserved as another choice for acute grade IV pancreatic injury. However, variant outcome and long-term ductal stricture reveal that the role of pancreatic duct stent is uncertain and may not be suitable for acute grade III pancreatic injury. However, it needs more clinical data to define the value in the acute blunt pancreatic duct injury.
Similar content being viewed by others
References
Barkin JS, Ferstenburg RM, Panullo W, Manten HD, Davis RC JR (1988) Endoscopic retrograde cholangiopancreatography in pancreatic trauma. Gastrointest Endosc 34: 102–105
Binmoeller KF, Jue P, Seifert H, Nam WC, Izbicki J, Soehendra N (1995) Endoscopic pancreatic stent drainage in chronic pancreatitis and a dominant stricture. Endoscopy 27: 638–644
Clements RH, Reisser JR (1996) Urgent endoscopic retrograde pancreatography in the stable trauma patient. Am Surg 62: 446–448
Cogbill TH, Moore EE, Kashuk JL (1982) Changing trends in the management of pancreatic trauma. Arch Surg 117: 722–728
Cremer M, Deviere J, Delhaye M, Baize M, Vandermeeren A (1991) Stenting in severe chronic pancreatitis: results of medium-term follow up in seventy-six patients. Endoscopy 23: 171–176
Feliciano DV, Martin TD, Cruse PA, Graham JM, Burch JM, Mattox KL, Bitondo CG, Jordan GLJ (1987) Management of combined pancreatoduodenal injuries. Ann Surg 205: 673–680
Fuji T, Amano R, Ohmura R, Akiyama T, Aibe T, Takemoto T (1989) Endoscopic pancreatic sphincterotomy- technique and evaluation. Endoscopy 21: 27–30
Huckfeldt R, Agee C, Nichols WK, Barthel J (1996) Nonoperative treatment of traumatic pancreatic duct disruption using an endoscopically placed stent. J Trauma 41: 143–144
Ikenberr SO, Sherman S, Hawes RH, Smith M, Lehman GA (1994) The occlusion rate of pancreatic stents. Gastrointest Endosc 40: 611–613
Jurkovich GJ, Carrico CJ (1990) Pancreatic trauma. Surg Clin North Am 70: 575–593
Kozarek RA (1990) Pancreatic stents can induce ductal changes consistent with chronic pancreatitis. Gastrointest Endosc 36: 93–95
Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW (1991) Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology 100: 1362–1370
Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL (2004) Management of blunt major pancreatic injury. J Trauma 56: 774–778
Moore EE, Cogbill T, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, McAninch JW, Patchter HL, Shackford SR, Trafton PG (1990) Organ injury scale II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma 30: 1427–1429
Patton JHJ, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, Fabian TC (1997) Pancreatic trauma: a simplified management guideline. J Trauma 43: 234–241
Smith ME, Badiga SM, Rauws EAJ, Tytgat GNJ, Huibregtse K (1995) Long-term results of pancreatic stents in chronic pancreatitis. Gastrointest Endosc 42: 461–467
Stone A, Sugawa C, Lucas C, Hayward S, Nakamura R (1990) The role of endoscopic retrograde pancreatography (ERP) in blunt abdominal trauma. Am Surg 56: 715–720
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: 745–752
Taxier M, Sivak MVJ, Cooperman AM, Sullivan BHJ, Ohio C (1980) Endoscopic retrograde pancreatography (ERP) in the evaluation of trauma to the pancreas. Surg Gynecol Obstet 150: 65–68
Yellin AE, Vecchione TR, Donovan AJ (1972) Distal pancreatectomy for pancreatic trauma. Am J Surg 124: 135–142
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lin, BC., Liu, NJ., Fang, JF. et al. Long-term results of endoscopic stent in the management of blunt major pancreatic duct injury. Surg Endosc 20, 1551–1555 (2006). https://doi.org/10.1007/s00464-005-0807-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0807-0