title: Spectrum and outcome of pancreatic trauma.
abstract: OBJECTIVE
  Pancreatic trauma is associated with high morbidity and mortality. Diagnosis is often difficult and surgery poses a formidable challenge.
  
  
  METHODS
  Data from 17 patients of pancreatic trauma gathered from a prospectively maintained database were analysed and the following parameters were considered: mode of injury, diagnostic modalities, associated injury, grade of pancreatic trauma and management. Pancreatic trauma was graded from I through IV, as per Modified Lucas Classification.
  
  
  RESULTS
  The median age was 39 years (range 19-61). The aetiology of pancreatic trauma was blunt abdominal trauma in 14 patients and penetrating injury in 3. Associated bowel injury was present in 4 cases (3 penetrating injury and 1 blunt trauma) and 1 case had associated vascular injury. 5 patients had grade I, 3 had grade II, 7 had grade III and 2 had grade IV pancreatic trauma. Contrast enhanced computed tomography scan was used to diagnose pancreatic trauma in all patients with blunt abdominal injury. Immediate diagnosis could be reached in only 4 (28.5%) patients. 7 patients responded to conservative treatment. Of the 10 patients who underwent surgery, 6 required it for the pancreas and the duodenum. (distal pancreatectomy with splenectomy-3, pylorus preserving pancreatoduodenectomy-1, debridement with external drainage-1, associated injuries-duodenum-1). Pancreatic fistula, recurrent pancreatitis and pseudocyst formation were seen in 3 (17.05%), 2 (11.7%) and 1 (5.4%) patient respectively. Death occurred in 4 cases (23.5%), 2 each in grades III and IV pancreatic trauma.
  
  
  CONCLUSIONS
  Contrast enhanced computed tomography scan is a useful modality for diagnosing, grading and following up patients with pancreatic trauma. Although a majority of cases with pancreatic trauma respond to conservative treatment, patients with penetrating trauma, and associated bowel injury and higher grade pancreatic trauma require surgical intervention and are also associated with higher morbidity and mortality.
authors.affiliation: Department of Surgical Gastroenterology, Seth GS Medical College & KEM Hospital, Parel, Mumbai-12.
authors.forename: Chetan V
authors.initials: CV
authors.lastname: Kantharia
authors.forename: R Y
authors.initials: RY
authors.lastname: Prabhu
authors.forename: A N
authors.initials: AN
authors.lastname: Dalvi
authors.forename: Abhijit
authors.initials: A
authors.lastname: Raut
authors.forename: R D
authors.initials: RD
authors.lastname: Bapat
authors.forename: Avinash N
authors.initials: AN
authors.lastname: Supe
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries*; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D014950:Wounds, Penetrating / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*