Local complications following pancreatic trauma.
BACKGROUND
Major trauma to the pancreas is uncommon, but associated with significant overall morbidity and mortality. A vast majority of these adverse outcomes can be attributed to the presences of associated injuries. Among those patients who survive the initial injury, however, the subsequent development of pancreas-related complications represents a significant source of adverse outcomes.


RESULTS
A total of 257 patients admitted from January 1996 to April 2007 were identified from the trauma registry database at our institution. One hundred and eighty-three patients surviving more than 48 h after admission were selected for analysis. These patients were grouped according to the surgical management utilised to address their pancreatic injuries: either resection or operative drainage. After exclusion of patients with associated vascular injuries, those undergoing drainage had lower rate of associated hollow viscus injuries (51.9% vs. 69.9%; p = 0.016) and lower rates of associated solid organ injuries (44.2% vs. 70.9%; p < or = 0.001). Patients undergoing drainage were noted to have a higher incidence of pseudocyst formation (19.5% vs. 9.0%; OR: 2.47, 95% CI, 0.92-6.67; p = 0.068), but lower hospital lengths of stay (18.7+/-18.5 vs. 33.8+/-63.5; p = 0.001). No difference in mortality was noted between the two populations (5.7% vs. 3.0%; p = 0.700). After multivariate analysis pseudocyst formation was the only complication that proved different between the two management groups, with patients undergoing operative drainage more commonly developing this adverse sequela (OR: 2.93, 95% CI, 1.02-8.36; p = 0.041).


CONCLUSIONS
In the absence of vascular injury, the choice of surgical management did not affect adjusted mortality or the overall occurrence of pancreas-related complications. Individuals treated with operative drainage alone, however, were significantly more likely to develop a post-operative pseudocyst than their resectional counterparts.
Recinos
Gustavo
G
Los Angeles County Hospital, University of Southern California School of Medicine, Los Angeles, CA, United States.
DuBose
Joseph J
JJ
Teixeira
Pedro G R
PG
Inaba
Kenji
K
Demetriades
Demetrios
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D004322:Drainage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010179:Pancreas / Q000293:injuries*; D010185:Pancreatic Fistula / Q000209:etiology; D010192:Pancreatic Pseudocyst / Q000209:etiology; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014684:Venae Cavae / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality / Q000601:surgery; D014950:Wounds, Penetrating / Q000150:complications* / Q000401:mortality / Q000601:surgery; D055815:Young Adult