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Ramzee AF, Bakhsh ZK, Al Jogol H, Rizoli S, Peralta R, El-Menyar A, Al-Thani H, AlMadani A. Trouble in Tiger country: isolated traumatic pancreatic transection - a case report. J Surg Case Rep 2023; 2023:rjad071. [PMID: 36846847 PMCID: PMC9950715 DOI: 10.1093/jscr/rjad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
Isolated pancreatic transection is a rare surgical condition that occurs more commonly following blunt abdominal trauma. It carries a high degree of morbidity and mortality, and the management remains a source of debate as universally accepted guidelines are not well established owing to the paucity in clinical experience and large series. We presented a case of an isolated pancreatic transection following blunt abdominal trauma. The surgical management of pancreatic transection has evolved over the decades from aggressive approaches to more conservative measures. Given the lack of large series and clinical experience, no universal consensus exists, except for applying damage control surgery and resuscitation principles in critically unstable patients. For transections of the main pancreatic duct, most recommend excision of the distal pancreas. Concerns over the iatrogenic complications of wide excisions, particularly diabetes mellitus, have led to reconsideration and more conservative approaches, but it may fail in some cases.
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Affiliation(s)
- Ahmed Faidh Ramzee
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zeenat Khuda Bakhsh
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Al Jogol
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sandro Rizoli
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ruben Peralta
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ayman El-Menyar
- Correspondence address. Clinical Research, Trauma and Vascular Surgery, Hamad General Hospital & Weill Cornell Medical College, Doha, Qatar. Tel: +97444396130; E-mail:
| | - Hassan Al-Thani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ammar AlMadani
- Department of Surgery, Trauma Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Tamrat G, Kejela S. Delayed distal pancreatectomy for isolated complete pancreatic disruption secondary to “trivial” blunt abdominal injury: A case report and literature review. Clin Case Rep 2022; 10:e6295. [PMID: 36093448 PMCID: PMC9446079 DOI: 10.1002/ccr3.6295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 08/08/2022] [Accepted: 08/17/2022] [Indexed: 11/12/2022] Open
Abstract
Pancreatic injury is a formidable diagnostic and therapeutic challenge owing to its relative rarity. Most injuries are from motor vehicle related injuries in blunt trauma patients. We present a 22‐year‐old male patient presented after sustaining a kick to the abdomen. He developed progressive abdominal pain with vomiting with delayed generalization of the pain and involuntary guarding. On initial exploratory laparotomy, suction drainage was inserted, and patient underwent delayed spleen sparing distal pancreatectomy on the 25th post‐admission day. Patient had smooth postoperative course and was discharged on the 7th postoperative day.
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Affiliation(s)
- Girmaye Tamrat
- Department of Surgery College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
| | - Segni Kejela
- Department of Surgery College of Health Sciences Addis Ababa University Addis Ababa Ethiopia
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Pavlidis ET, Psarras K, Symeonidis NG, Geropoulos G, Pavlidis TE. Indications for the surgical management of pancreatic trauma: An update. World J Gastrointest Surg 2022; 14:538-543. [PMID: 35979422 PMCID: PMC9258242 DOI: 10.4240/wjgs.v14.i6.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 03/17/2022] [Accepted: 05/14/2022] [Indexed: 02/06/2023] Open
Abstract
Pancreatic trauma is rare compared to other abdominal solid organ injuries, accounting for 0.2%-0.3% of all trauma patients. Moreover, this type of injury may frequently be overlooked or not readily appreciated on initial clinical examinations and investigations. The organ injury scale determines the severity of the trauma. Nonetheless, there are conflicting recommendations for the best strategy in severe cases. Overall, conservative management of induced severe traumatic pancreatitis is adequate. Modern imaging modalities such as ultrasound scanning and computed tomography scanning can detect injuries in fewer than 60% of patients. However, magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) have diagnostic accuracies approaching 90%-100%. Thus, management options include ERCP and stent placement or distal pancreatectomy in cases of complete gland transection and wide drainage only for damage control surgery, which can prevent mortality but increases the risk of morbidity. In the majority of cases, surgical intervention is not required and should be reserved for only severe grade III to grade V injuries.
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Affiliation(s)
| | - Kyriakos Psarras
- 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Nikolaos G Symeonidis
- 2nd Propedeutic Department of Surgery, School of Medicine, Aristotle University, Thessaloniki 54642, Greece
| | - Georgios Geropoulos
- Department of General Surgery, University College London Hospitals, London NW1 2BU, United Kingdom
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