title: Conservative and surgical management of pancreatic trauma in adult patients.
abstract: BACKGROUND
  The management of pancreatic trauma is complex. The aim of this study was to report our experience in the management of pancreatic trauma.
  
  
  METHODS
  All patients hospitalized between 2005 and 2013 for pancreatic trauma were included. Traumatic injuries of the pancreas were classified according to the American Association for Surgery of Trauma (AAST) in five grades. Mortality and morbidity were analyzed.
  
  
  RESULTS
  A total of 30 patients were analyzed (mean age: 38±17 years). Nineteen (63%) patients had a blunt trauma and 12 (40%) had pancreatic injury ≥ grade 3. Fifteen patients underwent exploratory laparotomy and the other 15 patients had nonoperative management (NOM). Four (13%) patients had a partial pancreatectomy [distal pancreatectomy (n=3) and pancreaticoduodenectomy (n=1)]. Overall, in hospital mortality was 20% (n=6). Postoperative mortality was 27% (n=4/15). Mortality of NOM group was 13% (n=2/15) in both cases death was due to severe head injury. Among the patients who underwent NOM, three patients had injury ≥ grade 3, one patient had a stent placement in the pancreatic duct and two patients underwent endoscopic drainage of a pancreatic pseudocyst.
  
  
  CONCLUSIONS
  Operative management of pancreatic trauma leads to a higher mortality. This must not be necessarily related to the pancreas injury alone but also to the associated injuries including liver, spleen and vascular trauma which may cause impaired outcome more than pancreas injury.
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Menahem
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France;; INSERM, U965, Paris, France.
authors.forename: Chetana
authors.initials: C
authors.lastname: Lim
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Eylon
authors.initials: E
authors.lastname: Lahat
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Michael
authors.initials: M
authors.lastname: Osseis
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Lacaze
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France;; INSERM, U955, Créteil, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Compagnon
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: Pascal
authors.affiliation: Department of Hepatobiliary, Pancreatic Surgery and Liver transplantation, Henri Mondor Hospital, Créteil, France;; INSERM, U955, Créteil, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
keywords: Pancreatic trauma; conservative treatment; endoscopic treatment; pancreatic resection; radiological drainage