Isolated main pancreatic duct injuries spectrum and management.
BACKGROUND
We present our experience with the rare injury of isolated major pancreatic duct disruption.


METHODS
From 1997 to 2003, 3 females and 13 males whose age ranged from 4 to 46 years were identified. Stabs caused 2 and blunt trauma 14 injuries. Nine presented acutely. Delay occurred in 7 patients, 6 with pseudocysts and 1 with infected pancreatic necrosis.


RESULTS
Nine cases were managed in the acute phase: 6 by splenic-preserving distal pancreatectomy and 2 by distal pancreatico-enteric anastomosis; 1 was drained. A small pseudocyst and transient pancreatic fistula were the only complications. The 6 cases with pseudocysts were managed endoscopically. Five were stented and 1 was drained without stent. Four had resolution. Two had stent cyst migration. One required a pancreaticojejunostomy and another distal pancreatectomy. One patient died of infected pancreatic necrosis. Long-term outcome could not be assessed.


CONCLUSIONS
In the acute situation, resection or distal pancreatico-enteric anastomoses are attainable with low morbidity. Endoscopic pseudocyst management options are feasible, with good short-term resolution. Giant cysts may be better managed operatively.
Department of Surgery, Addington Hospital, Nelson R. Mandela School of Medicine, University of Kwa Zulu Natal, Congella, South Africa.
Ines
I
Buccimazza
Sandie R
SR
Thomson
Frank
F
Anderson
Namasha M
NM
Naidoo
Damian L
DL
Clarke
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D005260:Female; D005774:Gastrostomy; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000293:injuries*; D010193:Pancreaticojejunostomy; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000000981:diagnostic imaging / Q000628:therapy*