title: Major pancreatic duct continuity is the crucial determinant in the management of blunt pancreatic injury: a pancreatographic classification.
abstract: To evaluate the management and outcomes of blunt pancreatic injuries based on the integrity of the major pancreatic duct (MPD).
  
  
  
  Between August 1996 and August 2015, 35 patients with blunt pancreatic injuries underwent endoscopic retrograde pancreatography (ERP). Medical charts were retrospectively reviewed for demography, ERP timing, imaging findings, management, and outcome.
  
  
  
  Of the 35 patients, 21 were men and 14 were women, with ages ranging from 11 to 70 years. On the basis of the ERP findings, we propose a MPD injury classification as follows: class 1 indicates normal MPD; class 2, partial injury with intact MPD continuity; and class 3, complete injury with disrupted MPD continuity. Both classes 2 and 3 are subdivided into classes a, b, and c, which represent the pancreatic tail, body, and head, respectively. In this report, 14 cases belonged to class 1, 10 belonged to class 2, and 11 belonged to class 3. Of the 14 patients with class 1 injuries, 10 underwent nonsurgical treatment and 4 underwent pancreatic duct stenting. Of the 10 patients with class 2 injuries, 4 underwent nonsurgical treatment and 6 underwent pancreatic duct stenting. Two of the 11 patients with class 3 injuries underwent pancreatic duct stenting; one in the acute stage developed sepsis that led to death even after converting to distal pancreatectomy plus splenectomy. Of the 11 patients with class 3 injuries, spleen-preserving distal pancreatectomy was performed in 6, distal pancreatectomy plus splenectomy in 2, and Roux-en-Y pancreaticojejunostomy after central pancreatectomy in 2. The overall pancreatic-related morbidity rate was 60% and the mortality rate was 2.8%.
  
  
  
  Based on our experience, class 1 and 2 injuries could be treated by nonsurgical means and pancreatic duct stenting could be an adjunctive therapy in class 2b and 2c injuries. Operation is warranted in class 3 injuries.
authors.affiliation: Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan, ROC. linbc@cgmh.org.tw.
authors.forename: Being-Chuan
authors.identifier: 0000-0002-5391-0900
authors.initials: BC
authors.lastname: Lin
authors.affiliation: Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC.
authors.forename: Yon-Cheong
authors.initials: YC
authors.lastname: Wong
authors.affiliation: Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC.
authors.forename: Ray-Jade
authors.initials: RJ
authors.lastname: Chen
authors.affiliation: Department of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC.
authors.forename: Nai-Jen
authors.initials: NJ
authors.lastname: Liu
authors.affiliation: Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC.
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC.
authors.forename: Tsann-Long
authors.initials: TL
authors.lastname: Hwang
authors.affiliation: Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan, ROC.
authors.forename: Yu-Pao
authors.initials: YP
authors.lastname: Hsu
mesh_terms: D000007:Abdominal Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000000981:diagnostic imaging* / Q000293:injuries / Q000601:surgery; D012016:Reference Values; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult
keywords: Blunt pancreatic injury; Endoscopic retrograde pancreatography; Major pancreatic duct continuity; Pancreatectomy; Pancreatic duct stenting