Endoscopic and operative treatment of delayed complications after pancreatic trauma: An analysis of 27 civilians treated in an academic Level 1 Trauma Centre

• Published in: Pancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 2015-09, Vol.15 (5), p.563-569
• Main Authors: Krige, J.E.J, Kotze, U.K, Navsaria, P.H, Nicol, A.J
• Format: Article
• Language: English
• Subjects: Abdomen; Abdominal Injuries - complications; Adolescent; Adult; Aged; Cysts; Drainage - methods; Endocrinology & Metabolism; Endoscopy; Endoscopy, Digestive System; Female; Fistula; Gastroenterology and Hepatology; Humans; Injury; Male; Middle Aged; Mortality; Pancreas; Pancreas - injuries; Pancreatic Fistula - etiology; Pancreatic Fistula - therapy; Pancreatic Pseudocyst - etiology; Pancreatic Pseudocyst - therapy; Pseudocyst; Retrospective Studies; Surgery; Trauma Centers; Treatment Outcome; Young Adult
• ISSN: 1424-3903; 1424-3911
• DOI: 10.1016/j.pan.2015.06.008

Abstract Background This study evaluated the efficacy of endoscopic treatment of delayed local complications including pseudocysts and persistent pancreatic fistulae in a cohort of civilian patients who had previously sustained a pancreatic injury. Method A large institutional database was interrogated to identify patients who developed a delayed pancreatic complication among those with pancreatic injuries treated between January 1990 and December 2013. The degree of the pancreatic duct injury was graded using a new duct injury grading system and endoscopic therapeutic outcome assessed according to the grade of injury. Results During the period under review, 432 consecutive patients were treated for pancreatic injuries of whom 27 (20 men, 7 women, median age 31, range 15–68 years) presented with delayed complications related to the initial pancreatic injury. Sixteen patients had non-resolving symptomatic pancreatic pseudocysts, 10 had persistent pancreatic fistulae and 1 had a symptomatic duct stricture. Fourteen patients with grade 2a, 3a, 3b or 4c main pancreatic duct injuries were successfully treated endoscopically with either pancreatic duct stenting or pseudocyst drainage while 13 patients with grade 4a or 4b duct injuries who had complete duct division with a disconnected duct syndrome failed endoscopic management and required surgical intervention. The 27 patients underwent a total of 49 endoscopic procedures (47 elective, 2 emergency) of whom 4 developed complications related to the endoscopic treatment. All 4 resolved, 2 after urgent endoscopic re-intervention. Conclusion In this preliminary analysis the Cape Town pancreatic ductal injury grading classification showed a close correlation with outcome after endoscopic and operative intervention.