Towards a non-operative strategy for severe blunt pancreatic injury—Case report

• Published in: Injury extra 2014-05, Vol.45 (5), p.35-39
• Main Authors: Chan, Kar-Vin, Cheung, Moon-Tong
• Format: Article
• Language: English
• Subjects: Non-operative management; Orthopedics; Pancreatic injury
• ISSN: 1572-3461; 1572-3461
• DOI: 10.1016/j.injury.2014.02.026

Abstract Background Pancreatic injury remains uncommon and the majority occurs in association with injury of other organs. For years, surgery has been advised for those with evidence of pancreatic duct damage. However, a lot of changes were seen in the management of blunt abdominal trauma, with strong support for non-operative management of solid organ injuries. There is strong evidence from paediatric patients that those with severe pancreatic contusion and ductal injury can be managed conservatively. Patients and method We present our cases of severe blunt pancreatic injury with ductal damage that were successfully managed non-operatively. We reviewed the literature to find evidence to support this management strategy. Result Our case report and the literature showed that majority of pancreatic ductal injury have been successfully managed non-operatively without increased morbidity or mortality. Conclusion Non-operative management of blunt pancreatic injury with ductal damage allows the formation of a pseudocyst for delayed drainage safely. This strategy of “induced pseudocyst” is particularly applicable to cases that present late and those with concomitant injuries of other organs. The majority of pseudocysts will subside by themselves. The use of embolization may decrease the need for urgent operation and timely percutaneous drainage may help relieve early symptoms.