Pancreatographic classification of pancreatic ductal injuries caused by blunt injury to the pancreas.
BACKGROUND
In the treatment of patients with pancreatic injury, the focus of attention is usually on main ductal injuries.


METHODS
To develop a classification system for pancreatic ductal injuries, we retrospectively analyzed blunt pancreatic injuries in 40 patients. We assessed the relationships between findings on pancreatography (36 endoscopic retrograde procedures and 4 transduodenal procedures), the treatment modality, and the clinical course.


RESULTS
Patients with class 1 injuries (radiographically normal ducts, n = 13) could be treated nonsurgically without major complications. Patients with class 2 injuries (branch injuries, n = 7), in whom contrast medium from ductal branches did not leak from the pancreatic parenchyma (class 2a, n = 3), could be treated nonsurgically. Patients with leaks into the retroperitoneal space (class 2b, n = 4) required at least a drainage laparotomy. Patients with class 3 injuries (main duct injuries, n = 20), including two patients in whom conservative treatment resulted in severe complications, required laparotomy.


CONCLUSIONS
This classification system for pancreatic ductal injuries may facilitate the selection of appropriate therapeutic modalities for patients with blunt pancreatic injury.
Takishima
T
T
Department of Surgery, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
Hirata
M
M
Kataoka
Y
Y
Asari
Y
Y
Sato
K
K
Ohwada
T
T
Kakita
A
A
D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000293:injuries*; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000150:complications*