Isolated and Combined Duodenal and Pancreatic Injuries: A Review and Update
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Purpose of Review
Duodenal and pancreatic injuries are challenging to diagnose and treat. Over the last several decades, appropriate and optimal surgical management of these injuries have been debated. This is a review of the latest literature regarding diagnosis and operative management of these injuries.
In duodenal injury, primary repair should be pursued for partial or complete transection with little tissue loss and no ampulla involvement. In more complex injuries, where tension-free repair is not possible, Roux-en-Y duodenojejunostomy or pyloric exclusion with diverting gastrojejunostomy can be utilized. Wide external closed suction drainage is recommended for grade I, II, and IV pancreatic injuries. Distal pancreatectomy with or without splenectomy is recommended for grade III injuries. Pancreatoduodenectomy in a staged procedure is safe for grade V combined injuries with ductal disruption.
Delayed diagnosis contributes to increased mortality in pancreatic and duodenal trauma. Establishing early diagnosis and ductal involvement followed by appropriate surgical intervention improves outcomes.
KeywordsDuodenal Pancreatic Injury Trauma Whipple Pancreatoduodenectomy
Compliance with Ethical Standard
Conflict of interest
Rachel L. Choron and David T. Efron declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: ∙ Of importance
- 1.Larrey Baron DJ. Memoirs of military surgery and campaigns [Translated from the French by R.W. Hall]. Vol. 3. Joseph Cushing, Baltimore. 1814;3:309–9.Google Scholar
- 2.Travers B. Rupture of the pancreas. Lancet. 1827;12:384.Google Scholar
- 25.Krige JE, Kotze UK, Hameed M, Nicol AJ, Navsaria PH. Pancreatic injuries after blunt abdominal trauma: an analysis of 110 patients treated at a level 1 trauma centre. S Afr J Surg. 2011;49:62–4.Google Scholar
- 32.Velmahos GC, Tabbara M, Gross R, Willette P, Hirsch E, Burke P, Emhoff T, Gupta R, Winchell RJ, Patterson LA, Manon-Matos Y, Alam HB, Rosenblatt M, Hurst J, Brotman S, Crookes B, Sartorelli K, Chang Y. Blunt pancreatoduodenal injury: a multicenter study of the Research Consortium of New England Centers for Trauma (ReCONECT). Arch Surg. 2009;144(5):413–9.CrossRefGoogle Scholar
- 36.∙ Ho VP, Patel NJ, Bokhari F, Madbak FG, Hambley JE, Yon JR, Robinson BR, Nagy K, Armen SB, Kingsley S, Gupta S, Starr FL, Moore HR 3rd, Oliphant UJ, Haut ER, Como JJ. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma. 2017; 82(1):185–99. Current guidelines by the national trauma society, EAST, for pancreatic injury management.CrossRefGoogle Scholar
- 39.Asensio JA, et al. Atlas and textbook of techniques in complex trauma surgery. Philadelphia: Saunders; 2005.Google Scholar
- 42.∙ Krige JE, Kotze UK, Setshedi M, Nicol AJ, Navsaria PH. Surgical management and outcomes of combined pancreaticoduodenal injuries: analysis of 75 consecutive cases. J Am Coll Surg. 2016; 222(5):737–49. A recent study, completed in 2016, of 75 consecutive combined duodenal and pancreatic injuries; one of the largest series to date.CrossRefGoogle Scholar
- 43.∙ Thompson CM., Shalhub S, DeBoard ZM, Maier RV. Revisiting the pancreaticoduodenectomy for trauma: a single institution’s experience. J. Trauma Acute Care Surg. 2013;75:225–28. A recent article reviewing their latest experience with pancreaticoduodenectomy in the traumatic setting.CrossRefGoogle Scholar