Missed pancreatic injury in patients undergoing conservative management of blunt abdominal trauma: Causes, sequelae and management
Vivek Gupta, Vikram Singh Sodha, Nitin Kumar, Vishal Gupta, Ravi Pate, Abhijit Chandra
Division of Surgical Gastroenterology, King George’s Medical University, Lucknow, India
Objective: Pancreas is a less commonly injured organ in blunt abdominal trauma. This study aimed to analyze the management and outcomes of patients in whom the pancreatic injury was missed during the initial evaluation of blunt abdominal trauma.
Material and Methods: We retrospectively (2009-2019) analyzed the details and outcome of patients who underwent conservative management of blunt abdominal trauma, where the diagnosis of pancreatic injury was missed for at least 72 hours following trauma.
Results: A total of 31 patients with missed pancreatic injury were identified. All patients were hemodynamically stable following trauma and most (21) were initially assessed only by an ultrasound. A delayed diagnosis of pancreatic injury was made at a mean of 28 (4 to 60) days after trauma when patients developed abdominal pain (31), distension (18), fever (10) or vomiting (8). On repeat imaging, 18 (58.1%) patients had high grade pancreatic injuries including complete transection or pancreatic duct injury. Seven (22.5%) patients were managed conservatively, seventeen (54.8%) underwent percutaneous drainage of intra-abdominal collections, seven (22.5%) underwent endoscopic or surgical drainage procedure for symptomatic pseudocyst. Eleven (35.4%) patients needed readmissions to manage recurrent pancreatitis, intra-abdominal abscess and pancreatic fistula. Three patients required pancreatic duct stenting for pancreatic fistula. There was no mortality.
Conclusion: Pancreatic injury may be missed in patients who remain hemodynamically stable with minimal clinical symptoms after abdominal trauma, especially if screened only by an ultrasound. In our series, there was significant morbidity of missed pancreatic injury.
Keywords: Pancreatic injury, missed injury, blunt trauma abdomen, ultrasound abdomen
Cite this article as: Gupta V, Sodha VS, Kumar N, Gupta V, Pate R, Chandra A. Missed pancreatic injury in patients undergoing conservative management of blunt abdominal trauma: Causes, sequelae and management. Turk J Surg 2021; 37 (3): 286-293.
The study was obtained from King George’s Medical University Instutional Ethics Committee (Date: 05.01.2021, Number: 20).
Concept –V.G., A.C.; Design – V.G., A.C.; Supervision –V.G., A.C.; Materials - All of authors; Data Collection and/or Processing - V.G., A.C., V.S.S., N.K.; Analysis and/or Interpretation – V.G., A.C., V.S.S., N.K.; Literature Search- All of authors; Writing Manuscript – V.G., A.C.; Critical Reviews – All of authors.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.