title: Distal pancreatectomy for trauma: a multicenter experience.
abstract: During a 5-year period, 74 patients with pancreatic injuries were managed by distal pancreatic resection at nine referral trauma centers. Patient ages ranged from 4 to 72 years. Injury mechanism was blunt trauma in 34 (46%) patients, gunshot wound in 27 (36%), stab wound in 11 (15%), and shotgun blast in two (3%). There were 19 class II, 50 class III, and 5 class IV pancreatic injuries. The resection comprised up to 33% of the pancreas in 21 (28%) patients, from 34% to 66% in 45 (61%), and greater than 67% in eight (11%). The pancreatic resection margin was closed with staples in 44 (59%), silk sutures in 20 (27%), and polypropylene sutures in eight (11%). Of 32 patients in whom the spleen was uninjured, the spleen was left intact in 17 (53%). There were nine (12%) deaths. The cause of death was irreversible shock in three patients, multiple organ failure in five, and severe head injury in one. Pancreas-related complications occurred in 32 (45%) of 71 patients who survived the initial operation. Intra-abdominal abscess developed in 24 patients; 11 were managed by percutaneous drainage alone. Pancreatic fistula developed in 10 patients; eight closed spontaneously from 6 to 54 days. Other pancreas-related morbidity included pancreatitis (6), pseudocyst (2), and hemorrhage (2). Exocrine insufficiency was not evident in any patient and diet-controlled hyperglycemia occurred in one individual following 80% pancreatic resection.(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Surgery of Gundersen/Lutheran Medical Center, La Crosse, Wisconsin.
authors.forename: T H
authors.initials: TH
authors.lastname: Cogbill
authors.forename: E E
authors.initials: EE
authors.lastname: Moore
authors.forename: J A
authors.initials: JA
authors.lastname: Morris
authors.forename: D B
authors.initials: DB
authors.lastname: Hoyt
authors.forename: G J
authors.initials: GJ
authors.lastname: Jurkovich
authors.forename: P
authors.initials: P
authors.lastname: Mucha
authors.forename: S E
authors.initials: SE
authors.lastname: Ross
authors.forename: D V
authors.initials: DV
authors.lastname: Feliciano
authors.forename: S R
authors.initials: SR
authors.lastname: Shackford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010289:Parenteral Nutrition, Total; D014947:Wounds and Injuries / Q000150:complications / Q000401:mortality / Q000601:surgery