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Management of Pancreatic Injury in the Geriatric Patient

  • Charles E. Lucas
  • Anna M. Ledgerwood
Chapter

Abstract

Surgeons always like to perform their magic on young adults who are in training in some athletic event for the upcoming Olympics. Unfortunately, our society continues to age so that more and more operations are performed in the elderly. The challenges of surgery in the geriatric population relate to the adverse events that aging has on both physical well-being and mental acumen. The extent of physical derangement is often referred to by the popular term “frailty” whereas the progressive mental deterioration often falls under the name of “Alzheimer’s disease.” Although aging, per se, is not the cause of fragility or reduced acumen, the trend is for both to become progressively worse each year. Clearly, the effect of fragility and decreased cognitive function impair successful surgical treatment. This is true not only for elective surgery but especially for emergency operations after injury.

Consequently, the treatment of pancreatic injury may differ in the frail elderly patient. Patients with grade I injury (small laceration) and grade II injury (larger laceration without major ductal injury) will more likely be treated by percutaneous drainage to avoid the insult of a major laparotomy. Patients with grade III injury (deep distal laceration with ductal injury) will more likely be treated with percutaneous drainage, deferring definitive treatment of a subsequent pseudocyst until the patient is more stable. Grade IV lacerations to the pancreatic head will likely be treated with exploration and wide extensive drainage without major organ resection. Patients with grade V injury (severe combined pancreatic head laceration with duodenal rupture) will more likely be treated with primary repair of the duodenal injury and wide extensive drainage of the associated pancreatic injury. Definitive treatment of complications of this ultra-conservative approach will be carried out when the patient is more stable.

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Michael and Marian Ilitch Department of SurgeryWayne State University School of MedicineDetroitUSA
  2. 2.Wayne State University School of MedicineDetroitUSA

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