Non-operative management of a grade IV pancreatic injury.
Isolated pancreatic transection with ductal disruption in blunt abdominal trauma is extremely rare. We report the case of a 14-year-old boy who suffered pancreatic transection at the junction of body and head of the pancreas; yet remarkably recovered after initial conservative management. He was periodically examined clinically and underwent regular abdominal ultrasonography. Nearly 6 months later, endoscopic retrograde cholangiopancreatography with pancreatic duct stenting, pancreatic sphincterotomy and cystogastrostomy for the pseudocyst diagnosed during the follow-up period was performed. Acute surgical management of pancreatic transection is fraught with high mortality and morbidity. Through this effort, we highlight the successful role of non-operative management of a haemodynamically stable patient with grade IV pancreatic injury, thereby avoiding radical surgery in the acute stage and preserving exocrine and endocrine function.
Department of General Surgery, M S Ramaiah Medical College and Hospital, Bangalore, Karnataka, India.
Bharati
B
Hiremath
Nishchit
N
Hegde
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D000293:Adolescent; D002760:Cholangiopancreatography, Endoscopic Retrograde; D005774:Gastrostomy; D006801:Humans; D008297:Male; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D015607:Stents; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000628:therapy*