title: Management of pancreatic trauma.
abstract: BACKGROUND
  Pancreatic trauma (PT) is associated with high morbidity and mortality; the therapeutic options remain debated.
  
  
  METHODS
  Retrospective study of PT treated in the University Hospital of Grenoble over a 22-year span. The decision for initial laparotomy depended on hemodynamic status as well as on associated lesions. Main pancreatic duct lesions were always searched for. PT lesions were graded according to the AAST classification.
  
  
  RESULTS
  Of a total of 46 PT, 34 were grades II or I. Hemodynamic instability led to immediate laparotomy in 18 patients, for whom treatment was always drainage of the pancreatic bed; morbidity was 30%. Eight patients had grade III injuries, six of whom underwent immediate operation: three underwent splenopancreatectomy without any major complications while the other three who had simple drainage required re-operation for peritonitis, with one death related to pancreatic complications. Four patients had grades IV or V PT: two pancreatoduodenectomies were performed, with no major complication, while one patient underwent duodenal reconstruction with pancreatic drainage, complicated by pancreatic and duodenal fistula requiring a hospital stay of two months. The post-trauma course was complicated for all patients with main pancreatic duct involvement. Our outcomes were similar to those found in the literature.
  
  
  CONCLUSIONS
  In patients with distal PT and main pancreatic duct involvement, simple drainage is associated with high morbidity and mortality. For proximal PT, the therapeutic options of drainage versus pancreatoduodenectomy must be weighed; pancreatoduodenectomy may be unavoidable when the duodenum is injured as well. Two-stage (resection first, reconstruction later) could be an effective alternative in the emergency setting when there are other associated traumatic lesions.
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: E
authors.initials: E
authors.lastname: Girard
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: J
authors.initials: J
authors.lastname: Abba
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: C
authors.initials: C
authors.lastname: Arvieux
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: B
authors.initials: B
authors.lastname: Trilling
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: P Y
authors.initials: PY
authors.lastname: Sage
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: N
authors.initials: N
authors.lastname: Mougin
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: S
authors.initials: S
authors.lastname: Perou
authors.affiliation: Réanimation post-chirurgicale, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France.
authors.forename: P
authors.initials: P
authors.lastname: Lavagne
authors.affiliation: Service de chirurgie digestive et de l'urgence, hôpital Michallon, CHU, boulevard de la Chantourne, 38700 La Tronche, France. Electronic address: cletoublon@chu-grenoble.fr.
authors.forename: C
authors.initials: C
authors.lastname: Létoublon
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D003131:Combined Modality Therapy; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000293:injuries / Q000601:surgery; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D013156:Splenectomy; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D055815:Young Adult
keywords: Diagnosis; Duodenum; Main pancreatic duct; Non-operative management; Pancreatectomy; Pancreatic trauma; Pseudocyst; Review; Treatment