title: Pancreatic injuries in earthquake victims: what have we learnt?
abstract: OBJECTIVE
  To analyze the clinical characteristic and management of patients with pancreatic injuries from the Wen-Chuan and Lu-Shan earthquakes.
  
  
  METHODS
  We retrospectively reviewed 39,784 patients from the Wen-Chuan earthquake and 1489 from the Lu-Shan earthquake. The demographics, clinical data, treatment strategies, and outcomes of patients with pancreatic injuries were recorded and compared between survivors of the two earthquakes.
  
  
  RESULTS
  Pancreatic injury occurred only in a small proportion (0.2%) in patients with trauma on admission, and most (61%) patients had Grades I-II pancreatic injuries. Blunt trauma was the leading cause of pancreatic trauma. Most patients (95%) suffered multiple injuries, of which chest injuries (61%) were the most common. Elevated serum amylase levels were observed in 50 (86%) of 58 patients, and computed tomography (CT) identified pancreatic injuries in 32 (80%) of 40 patients. A significantly higher rate (p = 0.043) of pancreatic complication was present in patients with Grade III and IV injuries (38%) than in those with Grade I and II injuries (18%). Forty patients were initially treated by conservative management with 6 (15%) requiring delayed operations. Four (67%) pancreatic complications and 2 (33%) deaths occurred in patients with delayed operations.
  
  
  CONCLUSIONS
  Repeated serum amylase analysis, CT, and laparoscopic exploration were reliable diagnostic modalities to diagnose pancreatic injury. Conservative management was safe in patients with Grade I and II injuries. Delayed operation, especially for Grade III patients, resulted in increased morbidity and mortality.
authors.affiliation: Department of Hepato-Biliary-Pancreato Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu 610041, Sichuan, China.
authors.forename: Kun-Lin
authors.initials: KL
authors.lastname: Xie
authors.forename: Jun
authors.initials: J
authors.lastname: Liu
authors.forename: Gang
authors.initials: G
authors.lastname: Pan
authors.forename: Wei-Ming
authors.initials: WM
authors.lastname: Hu
authors.forename: Mei-Hua
authors.initials: MH
authors.lastname: Wan
authors.forename: Wen-Fu
authors.initials: WF
authors.lastname: Tang
authors.forename: Xu-Bao
authors.initials: XB
authors.lastname: Liu
authors.forename: Hong
authors.initials: H
authors.lastname: Wu
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002681:China / Q000453:epidemiology; D002760:Cholangiopancreatography, Endoscopic Retrograde; D004322:Drainage; D055866:Earthquakes; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000628:therapy; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy; D011183:Postoperative Complications / Q000453:epidemiology / Q000628:therapy; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
keywords: Earthquake; Injury; Pancreas