Pancreatic injuries in earthquake victims: What have we learnt?

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2013-11, Vol.13 (6), p.605-609
• Main Authors: Xie, Kun-Lin, Liu, Jun, Pan, Gang, Hu, Wei-Ming, Wan, Mei-Hua, Tang, Wen-Fu, Liu, Xu-Bao, Wu, Hong
• Format: Article
• Language: English
• Subjects: Abdominal Injuries - epidemiology; Abdominal Injuries - therapy; Adolescent; Adult; Aged; Aged, 80 and over; Child; China - epidemiology; Cholangiopancreatography, Endoscopic Retrograde; Cysts; Drainage; Earthquakes; Endocrinology & Metabolism; Female; Gastroenterology and Hepatology; Humans; Injury Severity Score; Male; Middle Aged; Mortality; Multiple Trauma - epidemiology; Multiple Trauma - therapy; Pancreas; Pancreas - diagnostic imaging; Pancreas - injuries; Pancreas - surgery; Pancreatectomy; Postoperative Complications - epidemiology; Postoperative Complications - therapy; Respiratory distress syndrome; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography; Young Adult
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2013.10.002

Abstract Objective To analyze the clinical characteristic and management of patients with pancreatic injuries from the Wen-Chuan and Lu-Shan earthquakes. Methods We retrospectively reviewed 39,784 patients from the Wen-Chuan earthquake and 1489 from the Lu-Shan earthquake. The demographics, clinical data, treatment strategies, and outcomes of patients with pancreatic injuries were recorded and compared between survivors of the two earthquakes. Results Pancreatic injury occurred only in a small proportion (0.2%) in patients with trauma on admission, and most (61%) patients had Grades I–II pancreatic injuries. Blunt trauma was the leading cause of pancreatic trauma. Most patients (95%) suffered multiple injuries, of which chest injuries (61%) were the most common. Elevated serum amylase levels were observed in 50 (86%) of 58 patients, and computed tomography (CT) identified pancreatic injuries in 32 (80%) of 40 patients. A significantly higher rate ( p  = 0.043) of pancreatic complication was present in patients with Grade III and IV injuries (38%) than in those with Grade I and II injuries (18%). Forty patients were initially treated by conservative management with 6 (15%) requiring delayed operations. Four (67%) pancreatic complications and 2 (33%) deaths occurred in patients with delayed operations. Conclusions Repeated serum amylase analysis, CT, and laparoscopic exploration were reliable diagnostic modalities to diagnose pancreatic injury. Conservative management was safe in patients with Grade I and II injuries. Delayed operation, especially for Grade III patients, resulted in increased morbidity and mortality.