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- Title
The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma.
- Authors
Wolf, A.; bernhardt, J.; Patrzyk, M.; Heidecke, C.-D.
- Abstract
<bold>Background: </bold>Injuries to the pancreas following blunt abdominal trauma are rare due to its protected retroperitoneal position. Many pancreatic lesions remain unnoticed at first and only become apparent when complications arise or during treatment of other injuries. The mortality rate is between 12 and 30%, and if treatment is delayed it is as high as 60%.<bold>Methods: </bold>Using medical records over the past 5 years, we investigated when and in what circumstances endoscopic retrograde cholangiopancreaticography (ERCP) was used in the diagnosis and treatment of pancreas injuries after blunt abdominal trauma. Penetrating injuries were not taken into consideration.<bold>Results: </bold>An ERCP was performed on a total of five patients with suspected injuries to the pancreas after blunt abdominal trauma. No duct participation could be determined in three of the patients with a first degree pancreatic lesion. A 44-year-old woman sustained severe internal and external injuries after a traffic accident. Because of the nature of her injuries, pancreatic left resection with splenectomy was necessary. After the operation, a pancreatic fistula diagnosed. The ductus pancreaticus (DP) was successfully treated by stenting with the use of endoscopic retrograde pancreaticography. A 24-year old woman was kicked in the epigastrium by a horse. On the day after the incident, she complained of increasing pain in the upper abdomen, and she had elevated amylase and lipase levels. Computed tomography scan showed free fluid. Less than 48 h after the accident, ERCP was performed and a leakage in the DP in the head-body region (fourth degree) was identified. We placed a stent, and during the subsequent laparoscopy the omental bursa was flushed out and a drainage laid. After 14 days, the patient was sent home. We removed the drainage 4 weeks after the accident, and the stent after 12 weeks.<bold>Conclusion: </bold>The major advantage of the prompt retrograde discription of the pancreatobiliary system after an accident in which pancreas involvement is suspected is the more precise assessment of the extent of the injuries. If a stent is placed in the same session, it is possible to carry out definitive and interventional treatment.
- Subjects
ENDOSCOPIC surgery; MEDICAL care; PANCREATIC fistula; ABDOMINAL examination; HYDROLASES; SOCIAL indicators; DUODENUM surgery; DUODENUM injuries; PANCREATIC injuries; PANCREATIC surgery; PANCREATITIS diagnosis; PANCREATIC duct; ABDOMINAL injuries; ALGORITHMS; AMYLASES; ANIMAL experimentation; BLUNT trauma; COMPARATIVE studies; COMPUTED tomography; ENDOSCOPIC retrograde cholangiopancreatography; HORSES; LIPASES; RESEARCH methodology; MEDICAL cooperation; PANCREAS; PANCREATITIS; RESEARCH; SURGICAL stents; TRAFFIC accidents; ULTRASONIC imaging; BRUISES; EVALUATION research; SOCIAL services case management; RETROSPECTIVE studies; TRAUMA severity indices; MEDICAL drainage; DIAGNOSIS; WOUNDS &; injuries; SURGERY
- Publication
Surgical Endoscopy & Other Interventional Techniques, 2005, Vol 19, Issue 5, p665
- ISSN
1866-6817
- Publication type
journal article
- DOI
10.1007/s00464-003-9276-5