Pancreatic Trauma

Question 1

most common mechanism

Answer 1

> > The most common mechanism in pediatric patients is abdominal blunt trauma.

> > Direct compression of the epigastrium against the vertebral column and a blunt object (handlebar) is typically seen after bicycle injuries.

> > The most common segment of the pancreas affected is the body.

> > Penetrating injuries into the abdomen are the most common injuries seen in adults.

Question 2

complications

Answer 2

> > Undiagnosed pancreatic injuries are associated with significant complications, such as intraabdominal abscess, fistula, and fluid collections, in 60% of patients.

> > Pancreatic injuries should always be considered after epigastric compression during a car or bicycle accident.

Question 3

CT and MRCP

Answer 3

> > Findings such as peripancreatic hematomas, free fluid in the lesser sac, and abnormal thickening of Gerota fascia suggest pancreatic injury.

> > Studies have shown that MRCP provides excellent visualization of the pancreatic duct, peripancreatic fluid contiguous to fractured segments of the pancreas, and hemorrhage after nonpenetrating trauma

Question 4

Amylase ?

Answer 4

> > Isolated pancreatic amylase measurement is not recommended because up to 40% of patients with transected pancreatic duct have normal serum amylase levels.

> > Serial quantification levels increase the sensitivity of the assay

Question 5

pancreatic injury grading.

Answer 5

see

Question 6

Tx ?

Answer 6

> > Major pancreatic resections have been described in stable patients with isolated pancreatic injury.

> > damage control surgery is indicated for complex injuries or unstable patients.

> > Most pancreatic lesions can be temporarily controlled with drains.

> > Once the physiologic insult has been controlled, definitive treatment should be considered, if indicated.

> > Up to 75% of deaths occur within the 48 to 72 hours after trauma, and most are related to hypovolemic shock.