what is the treatment for minor pancreatic injury?

Full Answer

What are the surgical options for the treatment of Pancreatic injuries?

In most cases of blunt injury, surgical resection is not necessary. Small or superficial capsular tears, contusions, or hematomas are best managed without sutures. Wide drainage with soft closed suction drains suffices in 80-90% of patients with pancreatic injuries.

How do you treat a blunt injury in the pancreas?

Pancreatic Trauma Treatment & Management. Early surgical intervention with identification of ductal injuries has been shown to reduce the incidence of early and late complications and death. Intraoperative Details Blunt injury In most cases of blunt injury, surgical resection is not necessary.

What is a pancreas injury?

Pancreatic injury. Jump to navigation Jump to search. A pancreatic injury is some form of trauma sustained by the pancreas. The injury can be sustained through either blunt forces, such as a motor vehicle accident, or penetrative forces, such as that of a gunshot wound. The pancreas is one of the least commonly injured organs in abdominal trauma.

What is conservative management of acute pancreatic trauma?

Conservative management is mainly advocated for pancreatic trauma without ductal injuries. Computed tomography (CT) is routinely used as the first-line imaging modality in acute abdominal trauma cases and is helpful in recognizing injuries to the pancreas and other organs and their associated complications[8].

What is the most common intervention for a pancreas injury?

As with blunt trauma, examination and peripancreatic drainage is the most common intervention, but the range and severity of penetrating injuries to the pancreas are much more extreme. Resection of the tail or body is accomplished in a similar fashion and is technically simple, but injuries to the head and neck of the pancreas may require more creative and more difficult operative therapies.

How long after blunt trauma can you be cleared for pancreatic injury?

Patients who have experienced blunt trauma and who have stable hemodynamics and CT scans showing no evidence of pancreatic parenchymal fracture, parenchymal hematoma, parenchymal edema, fluid in the lesser sac, or retroperitoneal hematoma may be observed but should not be considered to be cleared for pancreatic injury for at least 72 hours. Any patient with blunt trauma who continues to have abdominal pain or who develops symptoms of pancreatic injury should be thoroughly reassessed for pancreatic injury and operative intervention. Cuenca and Islam reported success with nonoperative treatment of low-grade injuries. [ 9]

What is blunt trauma to the pancreas?

Significant blunt trauma to the pancreas with parenchymal fracture is easily visualized on exploration by noting the retroperitoneal hematoma around the pancreas at the spinal column. Patients with ductal injury usually require resection of the tail and body distal to the vertebral column, and patients with documented intact ductal systems may be drained and observed.

How does ATLS help with pancreatic injury?

Adherence to ATLS standards and adequate preparation for emergency surgery in patients with pancreatic injury reduces morbidity and mortality rates. Early surgical intervention with identification of ductal injuries has been shown to reduce the incidence of early and late complications and death.

What is the second most common cause of death related to pancreatic injury?

The second greatest cause of death related to pancreatic injury is noted in the ICU during the postoperative period . As might be expected, death is most common with massive injury of multiple organs and a history of significant blood loss.

How long does it take for a fistula to heal?

Fistula formation is the most frequently reported complication, but with wide local drainage and good nutrition and supportive care, fistulas usually resolve spontaneously within 2 weeks of injury. Prolonged output of greater than 250 mL/d for more than 2 weeks or outputs of 750 mL/d or more should prompt ERCP or other diagnostic evaluation of the ductal system. Somatostatin analogues have been reported anecdotally in multiple prospective randomized clinical trials to decrease fistula output and to facilitate closure, but they have not been proven to be of absolute benefit. The commercially available analogue is expensive and, if used, should be closely monitored for its effects in individual patients.

Is a blunt injury surgical resection necessary?

In most cases of blunt injury, surgical resection is not necessary. Small or superficial capsular tears, contusions, or hematomas are best managed without sutures. Wide drainage with soft closed suction drains suffices in 80-90% of patients with pancreatic injuries.

What is the best treatment for a pancreatic duct injury?

When there is no pancreatic duct injury, typically hemostasis and surgical drainage are the main form of treatment. Surgical repair is undertaken when there is evidence or suspicion of ductal injury. The type of surgery depends on the degree of the injury and its proximity to the mesenteric blood vessels that serve the pancreas. When injuries are not close to the mesenteric vessels, a distal pancreatectomy may be done; this procedure preserves much of the pancreas and usually avoids loss of its endocrine and exocrine functions. In severe cases of pancreaticoduodenal injury, a pancreaticoduodenectomy can be used. Common complications after surgery include pancreatitis, pancreatic fistula, abscess, and pseudocyst formation. Initial management of hemorrhage includes controlling it by packing the wound.

What is the pancreatic injury?

Emergency medicine. A pancreatic injury is some form of trauma sustained by the pancreas. The injury can be sustained through either blunt forces, such as a motor vehicle accident, or penetrative forces, such as that of a gunshot wound. The pancreas is one of the least commonly injured organs in abdominal trauma.

How to diagnose pancreatic injury?

The diagnosis of this form of injury can be challenging because of the pancreas' location inside the abdomen. The use of ultrasound can reveal fluid around the site of injury. Computed tomography (CT) can also be utilized as a non-invasive diagnostic tool, but its reliability is low; one retrospective case review found that computed tomography had either failed to find injuries or had underestimated the severity of injury in more than half of 17 pancreatic injury patients. Serum amylase has also been shown to be of limited diagnostic utility within the first three hours following injury. Management of a pancreatic injury can be difficult because other abdominal organs, such as the liver, usually have sustained trauma as well. Several common symptoms manifest hours after the injury such as tachycardia, abdominal distension, and midepigastric tenderness. Indications for surgical intervention include: peritonitis based on physical examination; hypotension in combination with a positive focussed assessment with sonography (ultrasound) for trauma (FAST); and pancreatic duct disruption based on the results of thin-cut computed tomography or endoscopic retrograde cholangiopancreatography (ERCP). Commonly, a laparotomy is done in order to directly visualize the injury, and generally this approach is the most accurate diagnostic method.

What is the classification of pancreatic injury?

Pancreatic injuries are classified according to the criteria of the American Association for the Surgery of Trauma (AAST). The grade of the trauma should be increased by one level for multiple injuries to the same organ. The description of the injury is that "based on most accurate assessment at autopsy, laparotomy, or radiological study." The pancreatic organ injury scale, as minimally modified, is:

Why is it so hard to manage pancreatic injury?

Management of a pancreatic injury can be difficult because other abdominal organs, such as the liver, usually have sustained trauma as well. Several common symptoms manifest hours after the injury such as tachycardia, abdominal distension, and midepigastric tenderness.

When was the pancreatic injury first reported?

The first recorded case of pancreatic injury was published in The Lancet in 1827. At the time, death as a result of injury was deemed to be "universal". The first successful surgery to repair a transected pancreas was performed in 1904 by Garré, who reported the case the following year.

When is a distal pancreatectomy done?

When injuries are not close to the mesenteric vessels, a distal pancreatectomy may be done; this procedure preserves much of the pancreas and usually avoids loss of its endocrine and exocrine functions. In severe cases of pancreaticoduodenal injury, a pancreaticoduodenectomy can be used.

What is the grade of pancreatic injury?

Grading the severity of pancreatic injury: grade I – minor contusion or laceration with no duct injury, grade II – major contusion or laceration with no duct injury, grade III – transection or major laceration with duct disruption in distal pancreas, grade IV – transection of proximal pancreas or major laceration with associated injury to the amp ulla, grade V – Massive disruption of the pancreatic head

What is the prognostic factor for pancreatic trauma?

Grading pancreatic injury is important to guide operative management. The most important prognostic factor is pancreatic duct disruption and, once ductal disruption has been confirmed, early surgical intervention should be considered and specialist HPB surgeons should be involved.

How to prevent strain from injury?

Rest. Stop any type of activity right away to protect the injury from the additional strain.

How to treat a cut that is bleeding out of control?

Rinse the wound under cool running water or saline wash then apply an adhesive bandage. Depending on the severity of the wound, some lacerations need to be evaluated for the possibility of needing stitches. If you think the cut bleeding is out of control, call EMS as soon as possible.

What to do for a minor cut?

For minor cuts and scrapes, the first thing to do is clean the wounded area gently with water and apply direct pressure until the bleeding stops . Rinse the wound under cool running water or saline wash then apply an adhesive bandage. Depending on the severity of the wound, some lacerations ...

Is minor injury a life threat?

Minor injuries are unfortunate but common in our everyday lives. They can be painful, but most of the time, they do not threaten your life, mobility, or long-term survival.

Is a minor injury considered a medical emergency?

But not all injuries are considered a medical emergency. You should be the one to decide whether an injury could be worthy of an adhesive bandage, or if worse, a trip to the ER. Minor injuries are unfortunate but common in our everyday lives. They can be painful, but most of the time, they do not threaten your life, mobility, or long-term survival.

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Using These Guidelines in Clinical Practice

Conclusion

• In summary, we propose the following recommendations: (1) For adult patients with grade I or II injury to the pancreas identified on CT scan, we conditionally recommend nonoperative management. (2) For adult patients with grade III or IV injury to the pancreas identified on CT sc…

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