Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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An analysis of 77 cases of pancreatic injuries at a level one trauma center: Outcomes of conservative and surgical treatments

  • Harbi Khalayleh (Department of Surgery, Kaplan Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Ashraf Imam (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Oded Cohen-Arazi (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Pikkel Yoav (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Brigitte Helou (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Bala Miklosh (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Alon J. Pikarsky (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem) ;
  • Abed Khalaileh (Department of Surgery, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem)
  • Received : 2021.10.19
  • Accepted : 2021.12.29
  • Published : 2022.05.31
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Abstract

Backgrounds/Aims: Traumatic pancreatic injury (TPI) is rare as an isolated injury. There is a trend to perform conservative treatment even in patients with complete duct dissection and successful treatment. This study reviewed our 20 years of experience in the management of TPI and assessed patient outcomes according to age group and treatment strategy. Methods: A retrospective analysis of patients diagnosed and treated with TPI at a level-I trauma center from 2000-2019. Patients were divided into two groups: adults and pediatrics. Conservative treatment cases were subjected to subgroup analysis. Level of evidence: IV. Results: Of a total of 77 patients, the mean age was 24.89 ± 15.88 years. Fifty-six (72.7%) patients had blunt trauma with motor vehicle accident. Blunt trauma was the predominant mechanism in 42 (54.5%) patients. Overall, 38 (49.4%) cases had grade I or II injury, 24 (31.2%) had grade III injury, and 15 (19.5%) had grade IV injury. A total of 30 cases had non-operative management (NOM). Successful NOM was observed in 16 (20.8%) cases, including eight (32.0%) pediatric cases and eight (15.4%) adult cases. Higher American association for the surgery of trauma (AAST) grade of injury was associated with NOM failure (16.7% for grade I/II, 100% for grade III, and 66.7% for grade IV injury; p = 0.001). An independent factor for NOM failure was female sex (69.2% in females vs. 29.4% in males; p = 0.03). Conclusions: High AAST grade TPI is associated with a high rate of NOM failure in both pediatric and adults.

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References

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