title: Endoscopic management of pancreatic injury due to abdominal trauma.
abstract: BACKGROUND
  There is limited experience with pancreatic endotherapy in patients with pancreatic injury due to trauma.
  
  
  OBJECTIVE
  To retrospectively evaluate our experience of endoscopic management of pancreatic trauma.
  
  
  METHODS
  Eleven patients (10 males and 1 female; mean age: 21.8±11.9 years) with pancreatic trauma.
  
  
  METHODS
  Endoscopic therapy. Patients with pseudocyst and a gastroduodenal bulge were treated with endoscopic transmural drainage. Pseudocysts without bulge or patients with external pancreatic fistula were treated with transpapillary drainage.
  
  
  RESULTS
  Seven patients (6 males, 1 female) were treated for symptomatic pseudocyst and 4 patients (all males) were treated for persistent external pancreatic fistula. Three patients with external pancreatic fistula had partial disruption of pancreatic duct (head: 2 cases; tail: 1 case) and were successfully treated with bridging pancreatic stent (2 cases) or bridging nasopancreatic drain (1 case) with resolution of external pancreatic fistula in 4 to 6 weeks. Of seven patients presenting with symptomatic pseudocyst (size range: 4-14 cm), two patients were successfully treated with cystogastrostomy and there has been no recurrence over a follow up of 20 and 16 months, respectively. Five patients underwent transpapillary drainage. Three patients had partial disruption and two had complete disruption. In the former, a bridging nasopancreatic drain was placed in one patient and stent in two patients. All three patients had resolution of pseudocyst within 8 weeks and there has been no recurrence over a follow-up of 11 to 70 months. In two patients with complete disruption, non-bridging stent did not resolve the pseudocysts and required surgery.
  
  
  CONCLUSIONS
  Pancreatic injury due to trauma can be effectively treated endoscopically.
authors.affiliation: Department of Gastroenterology, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, India. deepakkbhasin@gmail.com
authors.forename: Deepak Kumar
authors.initials: DK
authors.lastname: Bhasin
authors.forename: Surinder Singh
authors.initials: SS
authors.lastname: Rana
authors.forename: Chalapathi
authors.initials: C
authors.lastname: Rao
authors.forename: Rajesh
authors.initials: R
authors.lastname: Gupta
authors.forename: Ganga Ram
authors.initials: GR
authors.lastname: Verma
authors.forename: Mandeep
authors.initials: M
authors.lastname: Kang
authors.forename: Birinder
authors.initials: B
authors.lastname: Nagi
authors.forename: Kartar
authors.initials: K
authors.lastname: Singh
mesh_terms: D000007:Abdominal Injuries / Q000150:complications / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000293:injuries* / Q000601:surgery*; D010185:Pancreatic Fistula / Q000209:etiology / Q000601:surgery*; D010192:Pancreatic Pseudocyst / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult