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Wani RA, Sen SS. Isolated Duodenal Injury in Blunt Abdominal Trauma in Children: A Series of Five Cases. Afr J Paediatr Surg 2024; 21:267-270. [PMID: 38867499 DOI: 10.4103/ajps.ajps_164_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 05/15/2023] [Indexed: 06/14/2024] Open
Abstract
ABSTRACT Blunt abdominal trauma is one of the leading causes of trauma-related deaths in children. The commonly affected organs include the spleen, liver and kidneys, followed by uncommon ones such as the pancreas and intestine. Isolated duodenal injury is very rare and, at times, poses a diagnostic challenge due to the paucity of clinical symptoms and signs. Hence, delayed presentation is not uncommon. In this write-up, five such cases are presented with emphasis on their clinical presentation, diagnosis, management and outcome.
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Affiliation(s)
- Reyaz Ahmad Wani
- Department of Paediatric Surgery, Government Medical College, Superspeciality Hospital, Srinagar, Jammu and Kashmir, India
| | - Sandeep Singh Sen
- Department of General Surgery, Shri Ram Murti Smarak Institute of Medical Sciences, Bareilly, Uttar Pradesh, India
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2
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Staab V, Naganathan S, McGuire M, Pinto JM, Pall H. Gastrointestinal Perforation with Blunt Abdominal Trauma in Children. CHILDREN (BASEL, SWITZERLAND) 2024; 11:612. [PMID: 38929192 PMCID: PMC11201831 DOI: 10.3390/children11060612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/11/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024]
Abstract
Gastrointestinal tract perforation is uncommon in children, accounting for <10% of cases of blunt abdominal trauma. Diagnosis of bowel perforation in children can be challenging due to poor diagnostic imaging accuracy. Intra-abdominal free air is found only in half of the children with bowel perforation. Ultrasound findings are nonspecific and suspicious for perforation in only two-thirds of cases. A computer tomography (CT) scan has a sensitivity and specificity of 50% and 95%, respectively. Surgical decisions should be made based on clinical examination despite normal CT results. Management of bowel perforation in children includes primary repair in 50-70% and resection with anastomosis in 20-40% of cases.
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Affiliation(s)
- Victoriya Staab
- Department of Surgery and Pediatrics, K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (V.S.); (S.N.); (M.M.); (J.M.P.)
- Department of Surgery and Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Srividya Naganathan
- Department of Surgery and Pediatrics, K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (V.S.); (S.N.); (M.M.); (J.M.P.)
- Department of Surgery and Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Margaret McGuire
- Department of Surgery and Pediatrics, K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (V.S.); (S.N.); (M.M.); (J.M.P.)
- Department of Surgery and Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Jamie M. Pinto
- Department of Surgery and Pediatrics, K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (V.S.); (S.N.); (M.M.); (J.M.P.)
- Department of Surgery and Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
| | - Harpreet Pall
- Department of Surgery and Pediatrics, K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, Neptune, NJ 07753, USA; (V.S.); (S.N.); (M.M.); (J.M.P.)
- Department of Surgery and Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 07110, USA
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3
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Del Toro C, Cabrera-Aguirre A, Casillas J, Ivanovic A, Scortegagna E, Estanga I, Alessandrino F. Imaging spectrum of non-neoplastic and neoplastic conditions of the duodenum: a pictorial review. Abdom Radiol (NY) 2023; 48:2237-2257. [PMID: 37099183 DOI: 10.1007/s00261-023-03909-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 04/27/2023]
Abstract
Given its crucial location at the crossroads of the gastrointestinal tract, the hepatobiliary system and the splanchnic vessels, the duodenum can be affected by a wide spectrum of abnormalities. Computed tomography and magnetic resonance imaging, in conjunction with endoscopy, are often performed to evaluate these conditions, and several duodenal pathologies can be identified on fluoroscopic studies. Since many conditions affecting this organ are asymptomatic, the role of imaging cannot be overemphasized. In this article we will review the imaging features of many conditions affecting the duodenum, focusing on cross-sectional imaging studies, including congenital malformations, such as annular pancreas and intestinal malrotation; vascular pathologies, such as superior mesenteric artery syndrome; inflammatory and infectious conditions; trauma; neoplasms and iatrogenic complications. Because of the complexity of the duodenum, familiarity with the duodenal anatomy and physiology as well as the imaging features of the plethora of conditions affecting this organ is crucial to differentiate those conditions that could be managed medically from the ones that require intervention.
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Affiliation(s)
| | | | - Javier Casillas
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA
| | - Aleksandar Ivanovic
- Department of Diagnostic Imaging, Faculty of Medicine, Center for Radiology and MRI, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Indira Estanga
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA
| | - Francesco Alessandrino
- Division of Abdominal Imaging, Department of Radiology, Leonard M. Miller School of Medicine, University of Miami Health System, 1611 NW 12Th Ave, West Wing 279, Miami, FL, 33136, USA.
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Aceves-Ayala JM, Noriega-Velásquez AJ, Briceño-Fuentes A, Ortiz-Orozco CA, Rojas-Solís PF, Rivas-Quezada PX, Bautista-López CA. Delayed Primary Repair of Complex Duodenal Injury Associated to Multiorgan Failure Due to Blunt Abdominal Trauma. Surg J (N Y) 2023; 9:e92-e96. [PMID: 37700824 PMCID: PMC10495225 DOI: 10.1055/s-0043-1774404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/14/2023] [Indexed: 09/14/2023] Open
Abstract
Duodenal injuries are rare and difficult to diagnose, with an incidence between 1 and 5% in cases of abdominal trauma. We present the case of a 30-year-old man who suffered a motorcycle collision presented with a 24-hour history of abdominal pain, peritoneal tenderness, and hemodynamic instability. Imaging studies show evidence of free fluid in the perihepatic, perisplenic, and pelvic space. An exploratory laparotomy was performed, finding a grade III duodenal, grade V jejunal, and grade II pancreatic injuries. The basis of surgical treatment being a primary anastomosis of duodenal and jejunal injuries, which allowed discharging him home 8 days after surgery and without any complications in his follow-up.
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Affiliation(s)
| | | | - Alberto Briceño-Fuentes
- Surgery Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, México
- Department of Surgical Clinics, CUCS, University of Guadalajara, Guadalajara, México
| | | | | | | | - Carlos Alfredo Bautista-López
- Surgery Department, Hospital Civil de Guadalajara “Dr. Juan I. Menchaca”, Guadalajara, México
- Department of Surgical Clinics, CUCS, University of Guadalajara, Guadalajara, México
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5
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Gao J, Li H, Yang J, Wang J, Ai T, He P, Wei G, Xiang Z, Zhao S. Surgical management of duodenal injury: experience from 92 cases. Eur J Trauma Emerg Surg 2023; 49:1367-1374. [PMID: 36763155 DOI: 10.1007/s00068-023-02238-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 01/27/2023] [Indexed: 02/11/2023]
Abstract
PURPOSE Duodenal injury increases with traffic accidents, and delayed diagnosis or inappropriate operation increase mortality and complications. This study aimed to explore early recognition and timely surgical intervention. METHODS All patients with duodenal injuries treated operatively during the past 10 years were reviewed, and the data were analyzed retrospectively regarding the mechanism of injury, diagnostic and therapeutic methods, and outcome. RESULTS A total of 92 patients with duodenal injuries accounted for 7.3% of 1258 patients with abdominal injury. Of the 92 patients, 71 (77.17%) experienced blunt trauma, with traffic accidents accounting for 59.2% (42/71). In 35 patients, a preoperative diagnosis was obtained by reviewing abdominal signs, peritoneocentesis, and imaging. The remaining 57 patients underwent urgent laparotomy, through which a definitive diagnosis of duodenal injury was confirmed during the operation. In all 92 patients, the surgical procedures involved simple sutures; pedicled jejunal piece coverings; and various anastomoses following resection of the injured duodenal portion, including the Whipple procedure and damage-control surgery principles. The overall mortality rate was 12.0% (11/92) with deaths mainly occurring due to associated injuries. When excluding 2 cases of intraoperative death, there were 47 cases in the double-tube gastrostomy group and 43 cases in the traditional triple-tube group, with mortality rates of 10.64% and 9.30% in the two groups, respectively (χ2 = 0.045, P > 0.05). Postoperative complications occurred in 15 patients (18.5%). There was a high incidence of duodenal (or pancreatic/biliary) leakage. CONCLUSION Early diagnosis and operation of duodenal injury are crucial to reducing complications and mortality. Surgical methods should be based on injury grade, associated injuries, and vital signs. Double-tube gastrostomy can reduce complications such as intestinal obstruction.
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Affiliation(s)
- Jinmou Gao
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China.
| | - Hui Li
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Jun Yang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Jianbai Wang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Tao Ai
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Ping He
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Gongbin Wei
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Zhen Xiang
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
| | - Shanhong Zhao
- Department of Traumatology, Chongqing Emergency Medical Center, Central Affiliated Hospital of Chongqing University, Jiankang Road 1#, Yuzhong District, Chongqing, 400014, China
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Ibáñez Sanz L, Martínez Chamorro E, Borruel Nacenta S. El informe estructurado de la TC en el enfermo politraumatizado. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ahmed HM, Borg M, Saleem AEA, Ragab A. Multi-detector computed tomography in traumatic abdominal lesions: value and radiation control. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background, The context
A prospective study was conducted involving 81 patients (mean age, 20.79 years) with abdominal trauma who underwent ultrasonography and post-contrast CT on MDCT scanner. The total DLP for each patient was reviewed, and the effective dose was calculated. Purpose of the study to: explore the role of MDCT in assessing traumatic abdominal lesions, demonstrate radiation dose delivered by MDCT, and describe specific CT technical features to minimize radiation.
Results
The spleen was the most commonly injured organ (49.4%) followed by liver (39.5%) and kidney (24.7%). Pancreatic injury occurred in seven patients, whereas only two patients had intestinal injuries. One patient had adrenal injury. Minimal, mild and moderate free intra-peritoneal fluid collection was detected in 21 (25.9%), 47 (58%) and 10 (12.3%) patients, respectively. Only three (3.7%) patients had no collection. One patient had active uncontrolled bleeding and died. Radiation dose was below the detrimental level (calculated effective dose), with optimal image quality.
Conclusions
MDCT is sensitive to all types of traumatic abdominal lesions. Not only in determining the injury, but also in its grading. MDCT has affected the treatment directions, spotting a focus on conservative treatment by raising the diagnostic confidence.
FAST cannot be the sole imaging modality. The individual radiation risk is small but real. Advancements in medical imaging reduce radiation risk.
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Iacobellis F, Di Serafino M, Brillantino A, Mottola A, Del Giudice S, Stavolo C, Festa P, Patlas MN, Scaglione M, Romano L. Role of MRI in early follow-up of patients with solid organ injuries: How and why we do it? Radiol Med 2021; 126:1328-1334. [PMID: 34283337 DOI: 10.1007/s11547-021-01394-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/28/2021] [Indexed: 11/29/2022]
Abstract
Trauma represents one of the most common causes of death or permanent disability in the population below 50 years. At present, non-operative treatment is the commonly adopted strategy in hemodynamically stable patients with solid organ injuries, when there are not concomitant bowel and mesenteric injuries requiring a prompt surgical approach, but it may require multiple imaging follow-up examinations, especially in the case of major injuries. No data are available about magnetic resonance imaging utilization in the early follow-up of trauma patients with solid organ injuries, particularly in liver and spleen trauma. We report our preliminary experience in this field.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy.
| | - Antonio Brillantino
- Department of Emergency Surgery, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Arianna Mottola
- Trauma Center, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Santolo Del Giudice
- Trauma Center, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Ciro Stavolo
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Patrizio Festa
- Trauma Center, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
| | - Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Mariano Scaglione
- Department of Radiology, James Cook University Hospital, Middlesbrough, UK.,Teesside University School of Health and Life Sciences, Tees Valley, Middlesbrough, TS1 3BX, UK.,Department of Radiology, "Pineta Grande" Hospital, Via Domitiana Km. 30, 00 81030, Castel Volturno, CE, Italy.,Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "Antonio Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy
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Zhang D, Yan J, Siyin ST, Pang W, Chen Y. Nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children: a single center's experience. BMC Pediatr 2021; 21:75. [PMID: 33573611 PMCID: PMC7877105 DOI: 10.1186/s12887-021-02535-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Background The treatment of high-grade (III/IV/V) blunt pancreatic injuries remains controversial. The study aims to summarize and evaluate nonresection management of the pancreas for grade III and IV blunt pancreatic injuries in children. Methods Twenty children [6.9 (3–12) years] treated at our center between January 2010 and June 2018 were included in this study. Their medical records and the outpatient follow-up data within 12 weeks after discharge were retrospectively reviewed. Long-term follow-up was conducted by telephone in February 2020. Results Nine children developed complications, including 8 pancreatic pseudocysts and 1 abdominal infection, after treatment at external hospitals and were transferred to our center with an average length of stay of 33.8 (8–63) days. Eleven children were admitted to our hospital directly after injury, with an average length of stay of 47.5 (23–69) days. One child underwent emergency laparotomy for hemorrhagic shock and Roux-en-Y drainage of the distal pancreas. The remaining 10 children received conservative treatment: 7 developed pancreatic pseudocysts, 2 developed abdominal infections, and 1 recovered uneventfully. For children with pancreatic pseudocysts (15/20, 75.0%), 4 recovered after conservative treatment, 4 recovered after percutaneous puncture, 5 recovered after external drainage of the cyst, and 2 recovered after alimentary tract anastomosis. Three children (3/20, 15.0%) who developed abdominal infection recovered after abdominal irrigation and drainage. No child was admitted to the ICU or died. Four children (4/20, 20.0%) developed local pancreatic atrophy within 12 weeks after discharge, but no other long-term complications were observed. Conclusions Nonresection management of the pancreas could be a feasible option for children with grade III and IV blunt pancreatic injuries. Regular long-term follow-up is essential in terms of pancreatic function, especially in patients with pancreatic atrophy.
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Affiliation(s)
- Dan Zhang
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Jiayu Yan
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Sarah Tan Siyin
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center of Children's Health, Capital Medical University, Beijing, China. .,, Beijing, People's Republic of China.
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Cross-Sectional Imaging Evaluation of Vascular Lesions in the Gastrointestinal Tract and Mesentery. J Comput Assist Tomogr 2020; 44:870-881. [PMID: 33196596 DOI: 10.1097/rct.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Gastrointestinal (GI) tract and mesenteric vascular lesions can have various clinical presentations, of which GI bleeding is the most common. This collection of pathology is highly variable in etiology ranging from occlusive disease to vascular malformations to trauma to neoplasms which makes for a challenging workup and diagnosis. The advent of multiple imaging modalities and endoscopic techniques makes the diagnosis of these lesions more achievable, and familiarity with their various imaging findings can have a significant impact on patient management. In this article, we review the gamut of GI tract and mesenteric vascular lesions and their associated imaging findings.
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Ayoob AR, Lee JT, Herr K, LeBedis CA, Jain A, Soto JA, Lim J, Joshi G, Graves J, Hoff C, Hanna TN. Pancreatic Trauma: Imaging Review and Management Update. Radiographics 2020; 41:58-74. [PMID: 33245670 DOI: 10.1148/rg.2021200077] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Traumatic injuries of the pancreas are uncommon and often difficult to diagnose owing to subtle imaging findings, confounding multiorgan injuries, and nonspecific clinical signs. Nonetheless, early diagnosis and treatment are critical, as delays increase morbidity and mortality. Imaging has a vital role in diagnosis and management. A high index of suspicion, as well as knowledge of the anatomy, mechanism of injury, injury grade, and role of available imaging modalities, is required for prompt accurate diagnosis. CT is the initial imaging modality of choice, although the severity of injury can be underestimated and assessment of the pancreatic duct is limited with this modality. The time from injury to definitive diagnosis and the treatment of potential pancreatic duct injury are the primary factors that determine outcome following pancreatic trauma. Disruption of the main pancreatic duct (MPD) is associated with higher rates of complications, such as abscess, fistula, and pseudoaneurysm, and is the primary cause of pancreatic injury-related mortality. Although CT findings can suggest pancreatic duct disruption according to the depth of parenchymal injury, MR cholangiopancreatography and endoscopic retrograde cholangiopancreatography facilitate direct assessment of the MPD. Management of traumatic pancreatic injury depends on multiple factors, including mechanism of injury, injury grade, presence (or absence) of vascular injury, hemodynamic status of the patient, and associated organ damage. ©RSNA, 2020 See discussion on this article by Patlas.
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Affiliation(s)
- Andres R Ayoob
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - James T Lee
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Keith Herr
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Christina A LeBedis
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Ashwin Jain
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Jorge A Soto
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Jihoon Lim
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Gayatri Joshi
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Joseph Graves
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Carrie Hoff
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
| | - Tarek N Hanna
- From the Department of Radiology, University of Kentucky, 800 Rose St, MN 109-B, Lexington, KY 40536 (A.R.A., J.T.L.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (K.H., J.L., G.J., J.G., C.H., T.N.H.); and Department of Radiology, Boston University, Boston, Mass (C.A.L., A.J., J.A.S.)
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Sodagari F, Katz DS, Menias CO, Moshiri M, Pellerito JS, Mustafa A, Revzin MV. Imaging Evaluation of Abdominopelvic Gunshot Trauma. Radiographics 2020; 40:1766-1788. [DOI: 10.1148/rg.2020200018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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13
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Odedra D, Mellnick VM, Patlas MN. Imaging of Blunt Pancreatic Trauma: A Systematic Review. Can Assoc Radiol J 2020; 71:344-351. [PMID: 32063010 DOI: 10.1177/0846537119888383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE Despite several published reports on the value of imaging in acute blunt pancreatic trauma, there remains a large variability in the reported performance of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI). The purpose of this study is to present a systematic review on the utility of these imaging modalities in the acute assessment of blunt pancreatic trauma. In addition, a brief overview of the various signs of pancreatic trauma will be presented. METHODS Keyword search was performed in MEDLINE, EMBASE, and Web of Science databases for relevant studies in the last 20 years (1999 onward). Titles and abstracts were screened, followed by full-text screening. Inclusion criteria were defined as studies reporting on the effectiveness of imaging modality (US, CT, or MRI) in detecting blunt pancreatic trauma. RESULTS After initial search of 743 studies, a total of 37 studies were included in the final summary. Thirty-six studies were retrospective in nature. Pancreatic injury was the primary study objective in 21 studies. Relevant study population varied from 5 to 299. Seventeen studies compared the imaging findings against intraoperative findings. Seven studies performed separate analysis for pancreatic ductal injuries and 9 studies only investigated ductal injuries. The reported sensitivities for the detection of pancreatic injuries at CT ranged from 33% to 100% and specificity ranged from 62% to 100%. Sensitivity at US ranged from 27% to 96%. The sensitivity at MRI was only reported in 1 study and was 92%. CONCLUSION There remains a large heterogeneity among reported studies in the accuracy of initial imaging modalities for blunt pancreatic injury. Although technological advances in imaging equipment would be expected to improve accuracy, the current body of literature remains largely divided. There is a need for future studies utilizing the most advanced imaging equipment with appropriately defined gold standards and outcome measures.
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Affiliation(s)
- Devang Odedra
- Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Vincent M Mellnick
- Abdominal Imaging Division, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Michael N Patlas
- Division of Emergency/Trauma Radiology, Department of Radiology, McMaster University, Hamilton General Hospital, Hamilton, Ontario, Canada
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Polotsky M, Vadvala HV, Fishman EK, Johnson PT. Duodenal emergencies: utility of multidetector CT with 2D multiplanar reconstructions for challenging but critical diagnoses. Emerg Radiol 2019; 27:195-203. [PMID: 31836955 DOI: 10.1007/s10140-019-01735-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 09/27/2019] [Indexed: 01/07/2023]
Abstract
Duodenal pathology is an infrequent cause of acute abdominal pain for which patients present to the emergency department. Critical pathology on multidetector CT (MDCT) may be overlooked if the radiologist does not carefully evaluate the duodenum as part of the search pattern. Optimal MDCT protocols include intravenous contrast with multiplanar reconstructions (MPRs). A variety of etiologies ranging from infection to malignancy can involve the duodenum, for which interrogation with MPRs is most helpful given the anatomy and complex relationship with surrounding structures. The purpose of this review article is to highlight the importance of CT acquisition with multiplanar reconstructions and review the spectrum of emergent duodenal pathology, with the goal of ensuring accurate and timely diagnosis to best guide patient management.
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Affiliation(s)
- Mikhael Polotsky
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Harshna V Vadvala
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA.
| | - Elliot K Fishman
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
| | - Pamela T Johnson
- Department of Radiology and Radiological Science, Johns Hopkins Hospital, Johns Hopkins University, 601 North Caroline Street, Baltimore, MD, 21287, USA
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15
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Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Leppaniemi A, Augustin G, Reva V, Wani I, Kirkpatrick A, Abu-Zidan F, Cicuttin E, Fraga GP, Ordonez C, Pikoulis E, Sibilla MG, Maier R, Matsumura Y, Masiakos PT, Khokha V, Mefire AC, Ivatury R, Favi F, Manchev V, Sartelli M, Machado F, Matsumoto J, Chiarugi M, Arvieux C, Catena F, Coimbra R. Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines. World J Emerg Surg 2019; 14:56. [PMID: 31867050 PMCID: PMC6907251 DOI: 10.1186/s13017-019-0278-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/12/2022] Open
Abstract
Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.
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Affiliation(s)
- Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Leslie Kobayashi
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego, San Diego, USA
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | - Luca Ansaloni
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Walt Biffl
- Trauma Surgery Department, Scripps Memorial Hospital, La Jolla, CA USA
| | - Ari Leppaniemi
- General Surgery Department, Mehilati Hospital, Helsinki, Finland
| | - Goran Augustin
- Department of Surgery, Zagreb University Hospital Centre and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Viktor Reva
- General and Emergency Surgery, Sergei Kirov Military Academy, Saint Petersburg, Russia
| | - Imitiaz Wani
- Department of Surgery, DHS Hospitals, Srinagar, Kashmir India
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery, Foothills Medical Centre, Calgary, Alberta Canada
| | - Fikri Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Enrico Cicuttin
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Gustavo Pereira Fraga
- Trauma/Acute Care Surgery & Surgical Critical Care, University of Campinas, Campinas, Brazil
| | - Carlos Ordonez
- Trauma and Acute Care Surgery, Fundacion Valle del Lili, Cali, Colombia
| | - Emmanuil Pikoulis
- 3rd Department of Surgery, Attiko Hospital, National & Kapodistrian University of Athens, Athens, Greece
| | - Maria Grazia Sibilla
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Ron Maier
- Department of Surgery, Harborview Medical Centre, Seattle, USA
| | - Yosuke Matsumura
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Peter T. Masiakos
- Pediatric Trauma Service, Massachusetts General Hospital, Boston, MA USA
| | - Vladimir Khokha
- General Surgery Department, Mozir City Hospital, Mazyr, Belarus
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics and Gynecology, University of Buea, Buea, Cameroon
| | - Rao Ivatury
- General and Trauma Surgery, Virginia Commonwealth University, Richmond, VA USA
| | - Francesco Favi
- General, Emergency and Trauma Surgery Department, Bufalini Hospital, Cesena, Italy
| | - Vassil Manchev
- General and Trauma Surgery Department, Pietermaritzburg Hospital, Pietermaritzburg, South Africa
| | - Massimo Sartelli
- General and Emergency Surgery, Macerata Hospital, Macerata, Italy
| | - Fernando Machado
- General and Emergency Surgery Department, Montevideo Hospital, Montevideo, Uruguay
| | - Junichi Matsumoto
- Department of Emergency and Critical Care Medicine, Saint-Marianna University School of Medicine, Kawasaki, Japan
| | - Massimo Chiarugi
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisa, 2, 56124 Pisa, Italy
| | - Catherine Arvieux
- Clin. Univ. de Chirurgie Digestive et de l’Urgence, CHUGA-CHU Grenoble Alpes, UGA-Université Grenoble Alpes, Grenoble, France
| | - Fausto Catena
- Emergency and Trauma Surgery, Maggiore Hospital, Parma, Italy
| | - Raul Coimbra
- Department of General Surgery, Riverside University Health System Medical Center, Moreno Valley, CA USA
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16
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Iacobellis F, Laccetti E, Tamburrini S, Altiero M, Iaselli F, Di Serafino M, Gagliardi N, Danzi R, Rengo A, Romano L, Nicola R, Scaglione M. Role of multidetector computed tomography in the assessment of pancreatic injuries after blunt trauma: a multicenter experience. Gland Surg 2019; 8:184-196. [PMID: 31183328 DOI: 10.21037/gs.2019.02.02] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pancreatic injuries can occur from either penetrating or blunt abdominal trauma. While there are rare, especially in the setting of blunt abdominal trauma, they are associated with a mortality of up to 30%, and a morbidity of 60%. Multidetector computed tomography (MDCT) is the preferred imaging modality in patients with acute blunt abdominal trauma and for the detection of acute pancreatic injury. Magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) plays an important role in the follow-up of pancreatic injury. In this brief review, we discuss the main MDCT acute imaging findings as well as the complications. Finally, we discuss the role of MR and MRCP in follow up of patients with pancreatic injuries.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Ettore Laccetti
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Stefania Tamburrini
- Department of Radiology, "Ospedale del Mare" ASL NA1 Centro-Napoli, Naples, Italy
| | - Michele Altiero
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Francesco Iaselli
- Department of Radiology, "Ospedale del Mare" ASL NA1 Centro-Napoli, Naples, Italy
| | - Marco Di Serafino
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Nicola Gagliardi
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Roberta Danzi
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Alessandro Rengo
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy
| | - Luigia Romano
- Department of General and Emergency Radiology, "A. Cardarelli" Hospital, Naples, Italy
| | - Refky Nicola
- Department of Radiology, SUNY-Upstate University and Medical Center, Syracuse, NY, USA
| | - Mariano Scaglione
- Department of Diagnostic Imaging, "Pineta Grande" Hospital, Castel Volturno, CE, Italy.,Department of Radiology, Sunderland Royal Hospital, NHS, Sunderland, UK
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17
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Søreide K, Weiser TG, Parks RW. Clinical update on management of pancreatic trauma. HPB (Oxford) 2018; 20:1099-1108. [PMID: 30005994 DOI: 10.1016/j.hpb.2018.05.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 05/24/2018] [Accepted: 05/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic injury is rare and optimal diagnosis and management is still debated. The aim of this study was to review the existing data and consensus on management of pancreatic trauma. METHODS Systematic literature review until May 2018. RESULTS Pancreas injury is reported in 0.2-0.3% of all trauma patients. Severity is scored by the organ injury scale (OIS), with new scores including physiology needing validation. Diagnosis is difficult, clinical signs subtle, and imaging by ultrasound (US) and computed tomography (CT) non-specific with <60% sensitivity for pancreatic duct injury. MRCP and ERCP have superior sensitivity (90-100%) for detecting ductal disruption. Early ERCP with stent is a feasible approach for initial management of all branch-duct and most main-duct injuries. Distal pancreatectomy (±splenectomy) may be required for a transected gland distal to the major vessels. Early peripancreatic fluid collections are common in ductal injuries and one-fifth may develop pseudocysts, of which two-thirds can be managed conservatively. Non-operative management has a high success rate (50-75%), even in high-grade injuries, but associated with morbidity. Mortality is related to associated injuries. CONCLUSION Pancreatic injuries are rare and can often be managed non-operatively, supported by percutaneous drainage and ductal stenting. Distal pancreatectomy is the most common operative procedure.
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Affiliation(s)
- Kjetil Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Clinical Medicine, University of Bergen, Norway; Department of Gastrointestinal Surgery, Stavanger University Hospital, Norway.
| | - Thomas G Weiser
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK; Stanford University Department of Surgery, Section of Trauma and Critical Care, Stanford, CA, USA
| | - Rowan W Parks
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, UK
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18
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Choi AY, Bodanapally UK, Shapiro B, Patlas MN, Katz DS. Recent Advances in Abdominal Trauma Computed Tomography. Semin Roentgenol 2018; 53:178-186. [PMID: 29861009 DOI: 10.1053/j.ro.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Andrew Y Choi
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY.
| | - Uttam K Bodanapally
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland Medical Center, R. Adams Cowley Shock Trauma Center, Baltimore, MD
| | - Boris Shapiro
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
| | - Michael N Patlas
- Division of Emergency Radiology, Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Douglas S Katz
- Department of Radiology, NYU Winthrop Hospital, Mineola, NY
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19
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Juanpere S, Valls L, Serra I, Osorio M, Gelabert A, Maroto A, Pedraza S. Imaging of non-neoplastic duodenal diseases. A pictorial review with emphasis on MDCT. Insights Imaging 2018; 9:121-135. [PMID: 29388052 PMCID: PMC5893489 DOI: 10.1007/s13244-018-0593-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/23/2017] [Accepted: 01/02/2018] [Indexed: 12/21/2022] Open
Abstract
Abstract A wide spectrum of abnormalities can affect the duodenum, ranging from congenital anomalies to traumatic and inflammatory entities. The location of the duodenum and its close relationship with other organs make it easy to miss or misinterpret duodenal abnormalities on cross-sectional imaging. Endoscopy has largely supplanted fluoroscopy for the assessment of the duodenal lumen. Cross-sectional imaging modalities, especially multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), enable comprehensive assessment of the duodenum and surrounding viscera. Although overlapping imaging findings can make it difficult to differentiate between some lesions, characteristic features may suggest a specific diagnosis in some cases. Familiarity with pathologic conditions that can affect the duodenum and with the optimal MDCT and MRI techniques for studying them can help ensure diagnostic accuracy in duodenal diseases. The goal of this pictorial review is to illustrate the most common non-malignant duodenal processes. Special emphasis is placed on MDCT features and their endoscopic correlation as well as on avoiding the most common pitfalls in the evaluation of the duodenum. Teaching points • Cross-sectional imaging modalities enable comprehensive assessment of duodenum diseases. • Causes of duodenal obstruction include intraluminal masses, inflammation and hematomas. • Distinguishing between tumour and groove pancreatitis can be challenging by cross-sectional imaging. • Infectious diseases of the duodenum are difficult to diagnose, as the findings are not specific. • The most common cause of nonvariceal upper gastrointestinal bleeding is peptic ulcer disease.
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Affiliation(s)
- Sergi Juanpere
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain.
| | - Laia Valls
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Isabel Serra
- Department of Gastroenterology, Dr. Josep Trueta University Hospital, Girona, Spain
| | - Margarita Osorio
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Arantxa Gelabert
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Albert Maroto
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
| | - Salvador Pedraza
- Department of Diagnostic Imaging Institute (IDI) and Girona Biomedical Research Institute (IDIBGI), Dr. Josep Trueta University Hospital, Av/ Francia s/n, Girona, Spain
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20
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Moura FHB, Parreira JG, Mattos T, Rondini GZ, Below C, Perlingeiro JAG, Soldá SC, Assef JC. Ruling out intra-abdominal injuries in blunt trauma patients using clinical criteria and abdominal ultrasound. ACTA ACUST UNITED AC 2017; 44:626-632. [PMID: 29267560 DOI: 10.1590/0100-69912017006015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 09/28/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to identify victims of blunt abdominal trauma in which intra-abdominal injuries can be excluded by clinical criteria and by complete abdominal ultrasonography. METHODS retrospective analysis of victims of blunt trauma in which the following clinical variables were analyzed: hemodynamic stability, normal neurologic exam at admission, normal physical exam of the chest at admission, normal abdomen and pelvis physical exam at admission and absence of distracting lesions (Abbreviated Injury Scale >2 at skull, thorax and/or extremities). The ultrasound results were then studied in the group of patients with all clinical variables evaluated. RESULTS we studied 5536 victims of blunt trauma. Intra-abdominal lesions with AIS>1 were identified in 144 (2.6%); in patients with hemodynamic stability they were present in 86 (2%); in those with hemodynamic stability and normal neurological exam at admission in 50 (1.8%); in patients with hemodynamic stability and normal neurological and chest physical exam at admission, in 39 (1.5%); in those with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, in 12 (0.5%); in patients with hemodynamic stability, normal neurological, chest, abdominal and pelvic physical exam at admission, and absence of distracting lesions, only two (0.1%) had intra-abdominal lesions. Among those with all clinical variables, 693 had normal total abdominal ultrasound, and, within this group, there were no identified intra-abdominal lesions. CONCLUSION when all clinical criteria and total abdominal ultrasound are associated, it is possible to identify a group of victims of blunt trauma with low chance of significant intra-abdominal lesions.
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Affiliation(s)
| | - José Gustavo Parreira
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Emergency Department, São Paulo, SP, Brazil.,- Faculty of Medical Sciences of Santa Casa de São Paulo, Department of Surgery, São Paulo, SP, Brazil
| | - Thiara Mattos
- - Faculty of Medical Sciences of Santa Casa de São Paulo, Medical School, São Paulo, SP, Brazil
| | | | - Cristiano Below
- - Faculty of Medical Sciences of Santa Casa de São Paulo, Medical School, São Paulo, SP, Brazil
| | - Jacqueline Arantes G Perlingeiro
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Emergency Department, São Paulo, SP, Brazil.,- Faculty of Medical Sciences of Santa Casa de São Paulo, Department of Surgery, São Paulo, SP, Brazil
| | - Silvia Cristine Soldá
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Emergency Department, São Paulo, SP, Brazil.,- Faculty of Medical Sciences of Santa Casa de São Paulo, Department of Surgery, São Paulo, SP, Brazil
| | - José Cesar Assef
- - Irmandade da Santa Casa de Misericórdia de São Paulo, Emergency Department, São Paulo, SP, Brazil.,- Faculty of Medical Sciences of Santa Casa de São Paulo, Department of Surgery, São Paulo, SP, Brazil
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21
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Mungazi SG, Mbanje C, Chihaka O, Madziva N. Combined pancreatic and duodenal transection injury: A case report. Int J Surg Case Rep 2017; 39:285-287. [PMID: 28886391 PMCID: PMC5591448 DOI: 10.1016/j.ijscr.2017.08.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 08/20/2017] [Accepted: 08/21/2017] [Indexed: 11/18/2022] Open
Abstract
Pancreatic-duodenal injuries are rare. They are associated with high morbidity and mortality. Damage control or less complex surgery improves outcome.
Introduction Combined pancreatic-duodenal injuries in blunt abdominal trauma are rare. These injuries are associated with high morbidity and mortality, and their emergent management is a challenge. Case presentation We report a case of combined complete pancreatic (through the neck) and duodenal (first part) transections in a 24-year-old male secondary to blunt abdominal trauma following a motor vehicle crash. The duodenal stumps were closed separately and a gastrojejunostomy performed for intestinal continuity. The transacted head of pancreas main duct was suture ligated and parenchyma was over sewn and buttressed with omentum. The edge of the body and tail pancreatic segment was freshened and an end to side pancreatico-jejunostomy was fashioned. A drain was left in situ. Post operatively the patient developed a pancreatic fistula which resolved with conservative management. After ten months of follow up the patient was well and showed no signs and symptoms of pancreatic insufficiency. Discussion Lengthy, complex procedures in pancreatic injuries have been associated with poor outcomes. Distal pancreatectomy or Whipple’s procedure for trauma are viable options for complete pancreatic transections. But when there is concern that the residual proximal pancreatic tissue is inadequate to provide endocrine or exocrine function, preservation of the pancreatic tissue distal to the injury becomes an option. Conclusion Combined pancreatic and duodenal injuries are rare and often fatal. Early identification, resuscitation and surgical intervention is warranted. Because of the large number of possible combinations of injuries to the pancreas and duodenum, no one form of therapy is appropriate for all patients.
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Affiliation(s)
- Simbarashe Gift Mungazi
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Box 167 Avondale Harare, Zimbabwe.
| | - Chenesa Mbanje
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Box 167 Avondale Harare, Zimbabwe
| | - Onesai Chihaka
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Box 167 Avondale Harare, Zimbabwe
| | - Noah Madziva
- Department of Surgery, College of Health Sciences, University of Zimbabwe, Box 167 Avondale Harare, Zimbabwe
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22
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Affiliation(s)
- A N Smolyar
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
| | - K T Agakhanova
- Department of acute liver and pancreatic surgical diseases, Sklifosovsky Research Institute of Emergency Care, Moscow, Russia
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23
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Tarabay AW, Rocca A, Martin D, Zingg T, Halkic N, Leviver M, Daniel RT. Post-traumatic pancreatico-dural fistula: Case report and management challenges. Trauma Case Rep 2016; 5:7-12. [PMID: 29942848 PMCID: PMC6013006 DOI: 10.1016/j.tcr.2016.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 11/29/2022] Open
Abstract
Pancreatic injury can occur following high-energy blunt trauma to the torso. Although several types of pancreatic fistulas have been described in literature, we report to our knowledge, the first case of a pancreatico-dural fistula of traumatic origin. A 20-year-old male sustained a severe blow to the thoraco-abdominal region in the setting of a motorcycle accident. A total body scan revealed an AAST (American Association for the Surgery of Trauma) grade 4 splenic injury. A laparotomy with splenectomy and abdominal packing was performed. This was later followed by thoracolumbar instrumentation for posterior fixation of a T11–T12 transdiscal type C fracture with anterior subluxation of T11, according to the AO classification. Subsequent management was complicated by the persistence of a pseudomeningocele despite multiple surgical drainage procedures and a concomitant increase in retroperitoneal fluid collections. High levels of amylase and lipase in the pseudomeningocele fluid confirmed the presence of a pancreatico-dural fistula, due to a Wirsung duct rupture. This case report illiustrates the challenges in the management of this rare condition.
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Affiliation(s)
- Antonio W Tarabay
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Alda Rocca
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - David Martin
- Visceral Surgery Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Tobias Zingg
- Visceral Surgery Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Nermin Halkic
- Visceral Surgery Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Marc Leviver
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
| | - Roy T Daniel
- Neurosurgery Division, Neurosciences Department, CHUV (Centre Hospitalier Universitaire Vaudois), UNIL University, Lausanne, Switzerland
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24
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Zeidenberg J, Durso AM, Caban K, Munera F. Imaging of Penetrating Torso Trauma. Semin Roentgenol 2016; 51:239-55. [DOI: 10.1053/j.ro.2016.03.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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Gans B, Sodickson A. Imaging of Blunt Bowel, Mesenteric, and Body Wall Trauma. Semin Roentgenol 2016; 51:230-8. [PMID: 27287953 DOI: 10.1053/j.ro.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bradley Gans
- Department of Radiology, Division of Emergency Radiology, The Ohio State University, Columbus, OH.
| | - Aaron Sodickson
- Department of Radiology, Division of Emergency Radiology, Brigham and Women׳s Hospital, Boston, MA
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Trauma duodenal. Consecuencias del retraso en su diagnóstico. Cir Esp 2016; 94:204-5. [DOI: 10.1016/j.ciresp.2015.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/09/2015] [Indexed: 11/21/2022]
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