Reconstruction after pancreatic trauma by pancreaticogastrostomy.
BACKGROUND
Pancreatic lesions are very infrequent after closed abdominal trauma (5% of cases) with a complication rate that affects 30-40% of patients, and a mortality rate that can reach 39%. In our experience, closed abdominal traumatisms occurring at typical popular horse-riding festivals in our region constitute a high risk of pancreatic trauma. The purpose of the present paper is to raise awareness about our experience in the diagnosis and treatment of pancreatic lesions secondary to closed abdominal traumatism.


METHODS
We present the clinical cases of two young patients who, after suffering blunt abdominal trauma secondary to the impact of a horse during the celebration of typical horse-riding festival, were diagnosed with pancreatic trauma type III. The treatment was surgical in both cases and consisted in performing a pancreaticogastric anastomosis with preservation of the distal pancreas and spleen. The postoperative period was uneventful and, at present, both patients are asymptomatic.


CONCLUSIONS
Signs and symptoms caused by pancreatic lesion are unspecific and difficult to objectify. With some limitations CT is the imaging test of choice for diagnosis and staging in the acute phase. The Wirsung section is indication for surgical treatment. The most extended surgical procedure in these cases is the resection of pancreatic body, tail, and spleen.


CONCLUSIONS
The identification of a pancreatic injury after closed abdominal trauma requires a high suspicion based on the injury mechanism. A safer option may be the distal pancreatic preservation with pancreaticogastric anastomosis in grade III lesions with healthy pancreatic tissue.
General & Digestive Surgery Department, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Spain. Electronic address: martin_martin_g@icloud.com.
Gonzalo Martín
GM
Martín
General & Digestive Surgery Department, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Spain.
Patricia Jiménez
PJ
Morillas
General & Digestive Surgery Department, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Spain.
José C Rodríguez
JC
Pino
General & Digestive Surgery Department, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Spain.
José M Morón
JM
Canis
General & Digestive Surgery Department, Hospital Universitario Son Espases, Carretera de Valldemossa, 79, Palma de Mallorca, Spain.
Francesc X González
FX
Argenté
Blut abdominal trauma; Distal pancreatic preservation; Horse-riding abdominal; Pancreatic trauma; Pancreatogastrostomy; trauma