Document Detail

Extension of nonoperative management of blunt pancreatic trauma to include grade III injuries: a safety analysis.
MedLine Citation:
PMID:  19495865     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: In hemodynamically stable patients after blunt pancreatic trauma, the main pancreatic duct (MPD) disruption (American Association for the Surgery of Trauma [AAST] grade III-IV-V lesions) is usually treated surgically or by endoscopic stent placement, whereas injuries without duct involvement (grade I-II) are liable to medical treatment. To date, no evidence has been reported regarding nonoperative management (NoM) of grade III injuries. We aimed to evaluate the safety of extending medical management to include cases of distal MPD involvement (grade III).
PATIENTS AND METHODS: Data were collected on patients admitted after blunt pancreatic trauma between January 1999 and December 2007. Patients exhibiting hemodynamic instability or hollow organ perforations were excluded from this study, as they were surgically managed. In all remaining cases NoM was attempted. Antibiotic prophylaxis and early total enteral nutrition were routinely adopted. Grade III patients received octreotide during hospitalization and for 6 months after discharge.
RESULTS: Eleven patients (2 with grade I injury, 3 with grade II injury, and 6 with grade III injury, all diagnosed by contrast-enhanced helical CT) were included. Nonsurgical management was carried out in all of these patients. Among grade III patients, one developed a peripancreatic abscess; another, a pancreatic fistula. Both were successfully treated nonoperatively. The average length of hospital stay was similar in grade I-II and grade III patients. After a median follow-up of 57 months no mortality or pancreatic sequelae had occurred.
CONCLUSIONS: Under the aforementioned conditions, an attempt to extend NoM to include patients with AAST-grade III lesions can be justified. However, such a strategy demands continuous patient monitoring, because should the case worsen, surgery might become necessary.
Giacomo Pata; Claudio Casella; Ernesto Di Betta; Luigi Grazioli; Bruno Salerni
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  World journal of surgery     Volume:  33     ISSN:  1432-2323     ISO Abbreviation:  World J Surg     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-20     Completed Date:  2009-11-02     Revised Date:  2011-04-11    
Medline Journal Info:
Nlm Unique ID:  7704052     Medline TA:  World J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1611-7     Citation Subset:  IM    
Department of Medical and Surgical Sciences, 1st Division of General Surgery, University of Brescia, Viale Europa, 11, 25123, Brescia, Italy.
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MeSH Terms
Antibiotic Prophylaxis
Contrast Media
Enteral Nutrition
Follow-Up Studies
Gastrointestinal Agents / therapeutic use
Length of Stay / statistics & numerical data
Middle Aged
Octreotide / therapeutic use
Pancreas / injuries*
Severity of Illness Index
Tomography, X-Ray Computed
Wounds, Nonpenetrating / radiography,  therapy*
Reg. No./Substance:
0/Contrast Media; 0/Gastrointestinal Agents; 83150-76-9/Octreotide
Comment In:
World J Surg. 2011 Apr;35(4):933-4; author reply 935-6   [PMID:  21190113 ]

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