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Wu AA, Thompson ED, Cameron JL, He J, Burkhart RA, Burns WR, Lafaro KJ, Shubert CR, Canto MI, Fishman EK, Hruban RH. Distinctive Pathology Associated With Focal Stenosis of the Main Pancreatic Duct Secondary to Remote Trauma: A Long-term Complication of Seat Belt Pancreatitis. Am J Surg Pathol 2024; 48:726-732. [PMID: 38482693 DOI: 10.1097/pas.0000000000002207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
The radiologic finding of focal stenosis of the main pancreatic duct is highly suggestive of pancreatic cancer. Even in the absence of a mass lesion, focal duct stenosis can lead to surgical resection of the affected portion of the pancreas. We present four patients with distinctive pathology associated with non-neoplastic focal stenosis of the main pancreatic duct. The pathology included stenosis of the pancreatic duct accompanied by wavy, acellular, serpentine-like fibrosis, chronic inflammation with foreign body-type giant cell reaction, and calcifications. In all cases, the pancreas toward the tail of the gland had obstructive changes including acinar drop-out and interlobular and intralobular fibrosis. Three of the four patients had a remote history of major motor vehicle accidents associated with severe abdominal trauma. These results emphasize that blunt trauma can injure the pancreas and that this injury can result in long-term complications, including focal stenosis of the main pancreatic duct. Pathologists should be aware of the distinct pathology associated with remote trauma and, when the pathology is present, should elicit the appropriate clinical history.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Elliot K Fishman
- Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD
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Avila-Sanchez P, Pliego-Zermeño JA, Barron-Cervantes NM, Chan C. Complete Traumatic Rupture of the Pancreas by a Horse Saddle: A Case Report. Cureus 2024; 16:e52570. [PMID: 38371099 PMCID: PMC10874610 DOI: 10.7759/cureus.52570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Pancreatic trauma is one of the least observed diagnoses in the emergency room, much less in pediatric emergencies. Any cause of direct abdominal blunt trauma can cause it. With only a few cases presented in the literature, horse accidents have been associated with this complication, but it has been never seen in literature as a case where the horse-riding saddle is the one causing the pancreatic trauma, until now. Emphasizing the importance of an early diagnosis is the key point, but more importantly, to highlight that the correct diagnostic approach will grant the opportunity for a lesion in the main pancreatic duct to be identified, which will allow a timely surgical approach, increasing overall survival rates and decreasing morbidity in these patients. Here lies the importance of not only utilizing a specific study, such as a computerized tomography (CT) scan to evaluate abdominal trauma but also using other image studies that are better suited for pediatric patients, such as magnetic resonance image (MRI) with cholangiopancreatography (MRCP).
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Affiliation(s)
- Pablo Avila-Sanchez
- Hepato-Pancreato-Biliary Surgery, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City, MEX
| | | | | | - Carlos Chan
- Hepato-Pancreato-Biliary Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, MEX
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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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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: 2] [Impact Index Per Article: 1.0] [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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