Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
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The Role of Endoscopic Retrograde Cholangiopancreatography (ERCP) in the Treatment of Traumatic Pancreas Injury

외상성 췌장 손상에서 내시경적 담췌관 조영술의 역할

  • Jeong, Min-Young (Division of Trauma and Surgical Critical Care, Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Young-Hwan (Division of Trauma and Surgical Critical Care, Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kyoung, Kyu-Hyouck (Department of General Surgery, Inje University, Haeundae Paik Hospital) ;
  • Lee, Sung-Koo (Division of Gastroenterology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Hong, Suk-Kyung (Division of Trauma and Surgical Critical Care, Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center)
  • 정민영 (울산대학교 의과대학 서울아산병원 외과학교실 외상 및 중환자외과) ;
  • 김영환 (울산대학교 의과대학 서울아산병원 외과학교실 외상 및 중환자외과) ;
  • 경규혁 (인제대학교 의과대학 해운대백병원 외과학교실) ;
  • 이성구 (울산대학교 의과대학 서울아산병원 내과학교실 위장관내과) ;
  • 홍석경 (울산대학교 의과대학 서울아산병원 외과학교실 외상 및 중환자외과)
  • Received : 2011.09.15
  • Accepted : 2011.10.19
  • Published : 2011.12.31
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Abstract

Purpose: Blunt pancreatic injury has a high mortality rate, especially if adequate management is delayed. Although many guidelines exist for diagnosis and treatment, there is no consensus to date. Therefore, we analyzed the role of endoscopic retrograde cholangiopancreatography (ERCP) as a diagnostic and therapeutic tool for the treatment of traumatic pancreatic injury. Methods: We retrospectively reviewed the electronic medical records (EMR) database at Asan Medical Center (Seoul, South Korea) to identify all patients diagnosed with trauma to the pancreas between June 2003 and December 2010. Clinical and operative findings, CT (computed tomography) images, and ERCP findings were assessed. Results: A total of 40 patients were evaluated in this study. Of these, 14 patients underwent diagnostic ERCP, and 26 did not. Of the 14 patients who underwent diagnostic ERCP, 5 were found to have normal pancreatic ducts, thereby preventing a needless laparotomy in these patients. Of the patients diagnosed with ductal injury, four were treated with endoscopic intervention, and four underwent an exploratory laparotomy. The remaining patient was treated with radiologic intervention (percutaneous drainage) to manage pancreatic pseudocyst formation. Conclusion: Our findings suggest that ERCP is a beneficial diagnostic and therapeutic modality for the treatment of traumatic pancreatic injury.

Keywords

References

  1. Wolf A, Bernhardt J, Patrzyk M, Heidecke CD. The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc. 2005;19:665-669. https://doi.org/10.1007/s00464-003-9276-5
  2. Jones RC. Management of pancreatic trauma. Am J Surg 1985;150:698-704 https://doi.org/10.1016/0002-9610(85)90412-X
  3. Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin North Am 2007;87:1515-1532, x. https://doi.org/10.1016/j.suc.2007.08.007
  4. Cogbill TH, Moore EE, Feliciano DV, Hoyt DB, Jurkovich GJ, Morris JA, et al. Conservative management of duodenal trauma: a multicenter perspective. J Trauma 1990;30:1469-1475. https://doi.org/10.1097/00005373-199012000-00005
  5. Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF, Jr., Malangoni MA. Pancreatic trauma: a tenyear multi-institutional experience. Am Surg 1997;63: 598-604.
  6. Wind P, Tiret E, Cunningham C, Frileux P, Cugnenc PH, Parc R. Contribution of endoscopic retrograde pancreatography in management of complications following distal pancreatic trauma. Am Surg 1999;65:777-783.
  7. Patton JH, Jr., Fabian TC. Complex pancreatic injuries. Surg Clin North Am 1996;76:783-795. https://doi.org/10.1016/S0039-6109(05)70480-1
  8. Bhasin DK, Rana SS, Rawal P. Endoscopic retrograde pancreatography in pancreatic trauma: need to break the mental barrier. J Gastroenterol Hepatol 2009;24: 720-728. https://doi.org/10.1111/j.1440-1746.2009.05809.x
  9. Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL. Management of blunt major pancreatic injury. J Trauma 2004;56:774-778. https://doi.org/10.1097/01.TA.0000087644.90727.DF
  10. Kim HS, Lee DK, Kim IW, Baik SK, Kwon SO, Park JW, et al. The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc 2001;54:49-55. https://doi.org/10.1067/mge.2001.115733
  11. Rescorla FJ, Plumley DA, Sherman S, Scherer LR, 3rd, West KW, Grosfeld JL. The efficacy of early ERCP in pediatric pancreatic trauma. J Pediatr Surg 1995;30: 336-340. https://doi.org/10.1016/0022-3468(95)90585-5
  12. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma 1990;30:1427-1429. https://doi.org/10.1097/00005373-199011000-00035
  13. Osler T, Baker SP, Long W. A modification of the injury severity score that both improves accuracy and simplifies scoring. J Trauma 1997;43:922-925; discussion 5-6. https://doi.org/10.1097/00005373-199712000-00009
  14. Lin BC, Liu NJ, Fang JF, Kao YC. Long-term results of endoscopic stent in the management of blunt major pancreatic duct injury. Surg Endosc 2006;20:1551-1555. https://doi.org/10.1007/s00464-005-0807-0
  15. Fennema EM, Nellensteijn DR, Nieuwenhuijs VB, van Rheenen PF, Ten Duis HJ, Hulscher JB. [Pancreatic injury in abdominal trauma in children: difficult to diagnose and treat.]. Ned Tijdschr Geneeskd 2011;155: A2406.
  16. Valentino M, Ansaloni L, Catena F, Pavlica P, Pinna AD, Barozzi L. Contrast-enhanced ultrasonography in blunt abdominal trauma: considerations after 5 years of experience. Radiol Med 2009;114:1080-1093. https://doi.org/10.1007/s11547-009-0444-0
  17. Takishima T, Hirata M, Kataoka Y, Asari Y, Sato K, Ohwada T, et al. Pancreatographic classification of pancreatic ductal injuries caused by blunt injury to the pancreas. J Trauma 2000;48:745-751; discussion 51-2. https://doi.org/10.1097/00005373-200004000-00026
  18. Hancke S, Pedersen JF. Percutaneous puncture of pancreatic cysts guided by ultrasound. Surg Gynecol Obstet 1976;142:551-552.
  19. Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, et al. Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg 2007;42:629-635. https://doi.org/10.1016/j.jpedsurg.2006.12.025