Pancreatic Trauma

2019 ◽  
Author(s):  
James C. Becker ◽  
Brian C. Beldowicz ◽  
Gregory J. Jurkovich
Keyword(s):  
Pediatric Trauma ◽  
Pancreatic Injury ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Rare Occurrence ◽  
Pancreatic Trauma ◽  
Spleen Preserving ◽  
Pancreatic Injuries ◽  
Trauma Injury

Pancreatic injury continues to present challenges to the trauma surgeon. The relatively rare occurrence of these injuries (0.2–12% of abdominal trauma), the difficulty in making a timely diagnosis, and high morbidity and mortality rates following complications justify the anxiety these unforgiving injuries invoke 1-3. Mortality rates for pancreatic trauma range from 9 to 34%, with a mean rate of 19%. Complications following pancreatic injuries are alarmingly frequent, occurring in 30 to 60% of patients 4. Nonetheless, if recognized early, the treatment of most pancreatic injuries is straightforward, with low morbidity and mortality. This review contains 10 figures, 2 tables, and 65 references. Key Words : Pancreatic trauma, injury, pediatric trauma, ERCP, MRCP, spleen-preserving pancreatectomy

scholarly journals Review: Research Toward Safer Resection of the Cirrhotic Liver

HPB Surgery ◽  
2000 ◽  
Vol 11 (5) ◽  
pp. 285-297 ◽  
Author(s):  
M. A. J. Moser ◽  
N. M. Kneteman ◽  
G. Y. Minuk
Keyword(s):  
Surgical Technique ◽  
Liver Function ◽  
Mortality Rates ◽  
Cirrhotic Liver ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Hepatic Surgery ◽  
Postoperative Course ◽  
Cirrhotic Patients ◽  
Surgery Resection

Despite recent advances in hepatic surgery, resection of the cirrhotic liver continues to be fraught with high morbidity and mortality rates. As a result, for many patients requiring resection of HCC the postoperative course is complicated and the probability of cure is diminished by coexisting cirrhosis. In this review, we discuss the characteristics of the cirrhotic liver which make it poorly tolerant of resection and the most common complications that follow such surgery. The main purpose of this paper is to review recent attempts to identify interventions that might be beneficial to cirrhotic patients undergoing resection. These interventions include assessment of liver reserve, advances in surgical technique, and improvement in liver function and regeneration.

Novel Promising Technique for Traumatic Pancreatic Injury Management.

2020 ◽  
Author(s):  
Mohammed Hamada Takrouney ◽  
Vipul Prakash Bothara ◽  
Bhushan Jahhav ◽  
Mohamed Abdelkader Osman ◽  
Ibrahim Ali Ibrahim ◽  
...  
Keyword(s):  
Pancreatic Duct ◽  
Median Time ◽  
Main Pancreatic Duct ◽  
Primary Repair ◽  
Pancreatic Injury ◽  
Pancreatic Trauma ◽  
Average Hospital ◽  
Pancreatic Injuries ◽  
The Status ◽  
Average Operative Time

Abstract Introduction: Pancreatic injuries in children are relatively uncommon. The precise location of the injury, the status of the main pancreatic duct, and the time between diagnosis and intervention are a potentially useful guide for management decisions. We report a successful endoscopic simple primary repair with the pancreatic preservation even with transected main pancreatic duct without duct stenting.Patients and Methods: Between May 2017and December 2019, 3 patients with pancreatic trauma and duct transection underwent endoscopic (laparoscopic and robotic) repair. Demographics, Operative data, Postoperative complications, and clinical outcomes were documented and analyzed.Results: Three patients with pancreatic fractures, 2 patients with grade IV, and one patient grade III injury. The median age was 11 years, the median time of hospital admission after the trauma was 72 hours. The median time of surgical intervention was 24 hours. Average operative time was160 minute and the average hospital stay was 9 days with no recorded postoperative or follow up complications till now.Conclusion: Primary simple pancreatic repair is a promising and plausible technique for the management of pancreatic trauma, especially with duct transaction it maybe instead of all other modalities of pancreatic trauma treatment. We implore all pediatric surgery centers to espouse this technique.

scholarly journals Endoscopic cyst gastrostomy for traumatic pancreatic pseudocysts in children: a case series

2020 ◽  
Vol 5 (1) ◽  
pp. e000456 ◽  
Author(s):  
Bethany J Farr ◽  
Victor L Fox ◽  
David P Mooney
Keyword(s):  
Trauma Center ◽  
Trauma Registry ◽  
Pediatric Trauma ◽  
Case Series ◽  
Pancreatic Pseudocysts ◽  
Pancreatic Trauma ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Pancreatic Injuries ◽  
Level 1

BackgroundPancreatic pseudocysts may develop after high-grade pancreatic injuries in children. Many resolve without intervention, and the management of symptomatic pseudocysts that persist remains controversial, with various open, percutaneous and laparoscopic approaches to intervention described. Successful endoscopic cyst gastrostomy has been reported in children with pancreatic pseudocysts of mixed etiology.MethodsThe trauma registry and electronic medical record of a level 1 pediatric trauma center were queried for children with a symptomatic pseudocyst following pancreatic trauma over a 12-year period, from 2008 to 2019.ResultsWe describe a case series of five consecutive children with persistent symptomatic pancreatic pseudocysts following blunt abdominal trauma all successfully treated with endoscopic cyst gastrostomy.DiscussionEndoscopic cyst gastrostomy appears to be safe and effective in the management of symptomatic pancreatic pseudocysts in children following pancreatic trauma.Level of evidence5 – retrospective case series.

Pediatric Thoraco-Abdominal Trauma

2020 ◽  
pp. 405-409
Author(s):  
Christopher S. Amato
Keyword(s):  
Abdominal Trauma ◽  
Thoracic Trauma ◽  
Pediatric Trauma ◽  
Medical Personnel ◽  
Abdominal Injury ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Common Cause ◽  
Thoracic And Abdominal ◽  
Trauma Deaths

In children, injury is the most common cause of death. Thoracic and abdominal trauma are both associated with high morbidity and mortality, and they warrant a thorough evaluation. Abdominal trauma occurs in 25% of children with major trauma and is responsible for 9% of all trauma deaths. Because it can delay care, lack of recognition of intra-abdominal injury increases morbidity and mortality. Thoracic trauma comprises only 4–6% of pediatric trauma but is related to 14% of pediatric trauma-related deaths and is the second most common cause of mortality in pediatric trauma. This chapter discusses the keys to the evaluation of the pediatric trauma patient with thoraco-abdominal injury, including the evidence-based approach and algorithms to be utilized by medical personnel.

scholarly journals Surgical management of traumatic pancreatic injuries and their consequences.

2020 ◽  
Vol 7 (11) ◽  
pp. 3555
Author(s):  
Ashraf Mohammad El-badry ◽  
Mohamed Mahmoud Ali
Keyword(s):  
Surgical Management ◽  
Damage Control ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
University Hospital ◽  
Pancreatic Trauma ◽  
Surgical Interventions ◽  
Pancreatic Injuries ◽  
Group A ◽  
Group B

Background: Management of pancreatic trauma remains challenging due to difficulty in diagnosis and complexity of surgical interventions. In Egypt, reports on pancreatic trauma are scarce.Methods: Medical records of adult patients with pancreatic trauma who were admitted at Sohag University Hospital (2012-2019) were retrospectively studied. Patients were categorized into group A of non-operative management (NOM), group B which required upfront exploratory laparotomy due to hemodynamic instability and group C in which surgical management was implemented after thorough preoperative assessment. Pancreatic injuries were ranked by the pancreas injury scale (PIS).Results: Thirty-two patients (25 males and 7 females) were enrolled, and median age of 36 (range: 23-68) years. Twenty-eight patients (87.5%) had blunt trauma whereas penetrating injury occurred in 4 (12.5%). There were 9 patients in group A, 7 in group B and 16 in group C. High grades of pancreatic injury ≥3 occurred in 4 patients from group B and 5 from group C. Distal pancreatectomy was performed in 7 patients while central resection and panceatico-gastrostomy in one. Grade IV injury occurred only in one patient who received damage-control laparotomy. Post-operative complication were significantly increased in group B compared with C, in correlation worse hemodynamic status and increased severity of PIS. Post-operative mortality occurred in 2 patients (6%), both from group B. Late consequences included pancreatic pseudocyst (4 cases) and walled off pancreatic necrosis (2 cases).Conclusions: High grades of pancreatic injury and hemodynamic instability correlate with worse outcome after surgery for pancreatic trauma.

scholarly journals Imaging of Pancreatic Trauma—A Clinical Scenario-Based Approach

2020 ◽  
Vol 3 (01) ◽  
pp. 028-034
Author(s):  
Naren Hemachandran ◽  
Shivanand Gamanagatti
Keyword(s):  
Magnetic Resonance ◽  
Abdominal Trauma ◽  
Clinical Signs ◽  
Vascular Complications ◽  
Pancreatic Injury ◽  
High Morbidity ◽  
Pancreatic Trauma ◽  
Clinical Scenarios ◽  
Management Of Complications ◽  
Secondary Signs

AbstractPancreatic injury, although uncommon in the setting of abdominal trauma, is associated with high morbidity and mortality. While the clinical signs are nonspecific, the imaging signs can be very subtle in the early stages leading to missed injuries that present later as complications. Contrast-enhanced computed tomography (CT) is the main workhorse and initial imaging modality in the setting of abdominal trauma, while magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography is used as a problem-solving tool in pancreatic trauma.This article provides a review of the imaging of pancreatic trauma and has been organized into common clinical scenarios–Suspected pancreatic injury with normal-appearing pancreas on CT; definite pancreatic injury on CT, late presentation or complication in a patient with pancreatic injury. The role of the radiologist in each scenario is described as follows: to identify subtle secondary signs of injury and resort to MRI or a repeat imaging wherever necessary in a suspected pancreatic injury with normal-appearing pancreas on CT (Scenario 1); to look for primary/hard signs, grade the injury according to American Association of Surgery for Trauma Organ Injury Scale, and utilize MRI if necessary to ascertain the presence of ductal injury when a definite pancreatic injury is seen on CT (Scenario 2); and to diagnose various complications and help in the management of complications such as draining collections or vascular complications like pseudoaneurysms (Scenario 3).Radiologists should be aware of the primary and secondary signs of pancreatic injury so as to enable prompt diagnosis and further management. Radiologists play an important role not only in the diagnosis of pancreatic injuries but also in the management of certain complications.

Emergent Right Hemicolectomies

2005 ◽  
Vol 71 (8) ◽  
pp. 653-657 ◽  
Author(s):  
Amy D. Wyrzykowski ◽  
David V. Feliciano ◽  
Timothy A. George ◽  
Lorraine N. Tremblay ◽  
Grace S. Rozycki ◽  
...  
Keyword(s):  
Damage Control ◽  
Primary Anastomosis ◽  
Bowel Perforation ◽  
Demographic Data ◽  
Wound Dehiscence ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Trauma Patients ◽  
Abdominal Abscess

Emergent right hemicolectomies have historically been associated with surprisingly high morbidity and mortality rates. A retrospective review of emergent right hemicolectomies over a 7-year period was performed to assess current morbidity and mortality. Emergent right hemicolectomy was defined as a procedure performed for an acute abdomen with no formal preoperative cleansing of the colon. Demographic data, diagnostic evaluation, length of stay and outcomes were evaluated. Over the study period, 122 emergent right hemicolectomies were performed on both general surgery and trauma patients. The average patient was 52.9 ± 18.5 years old, and the majority of patients (66.4%) were male. The indications for the procedures performed were bowel perforation (51), hemorrhage (25), cancer (16), benign obstruction (14), phlegmon (8), ischemia (6), or other (2). Resection with primary anastomosis was performed in 98 patients, 16 had an end ileostomy, and 8 underwent damage control procedures in which gastrointestinal continuity was not reestablished at the time of the original operation. Postoperative complications developed in 48 patients (39.3%). The majority of the complications (83.3%) were related to infection including intra-abdominal abscess (21 patients), sepsis (16), and wound infection (5). Other complications included anastomotic leak (5), wound dehiscence (3), stoma-related (3) and postoperative bowel obstruction (2). The patients who developed complications did not differ from those who had an uneventful postoperative course in terms of age, indication for procedure, or presence of intra-abdominal abscess or gross contamination at the time of the original procedure. The overall mortality rate was 13 per cent. Patients who died were older than those who lived (63 ± 19 vs 52 ± 18; P = 0.03) and were significantly more likely to have evidence of shock on presentation ( P = 0.0013). Emergent right hemicolectomies continue to be associated with high morbidity and mortality rates. The most common complications are related to infection. Age and manifestations of shock at the time of admission are strong predictors of mortality.

scholarly journals A rare case of myelodysplastic syndrome with refractory thrombocytopenia

2015 ◽  
Vol 7 (3) ◽  
Author(s):  
Waqas Jehangir ◽  
John Webb ◽  
Shilpi Singh ◽  
Sabrina Arshed ◽  
Shuvendu Sen ◽  
...  
Keyword(s):  
Rare Case ◽  
Treatment Options ◽  
Gene Mutations ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
Genetic Mutations ◽  
Specific Gene ◽  
High Morbidity ◽  
Risk Patients ◽  
Evidenced Based

Myelodysplastic syndromes (MDS) represent a variety of clonal abnormalities, possibly preleukemic and display numerous phenotypic manifestations. Specific mutations carry high morbidity and mortality rates due to cell line dysplasia. MDS commonly presents with symptoms related to anemia, and approximately two-thirds will develop thrombocytopenia, a rare, but potentially lethal complication that increases complexity in treatment and morbidity, and may be due to unique genetic mutations leading to refractory thrombocytopenia, ultimately leading to an overall reduction in survival. Careful identification and monitoring of this patient subdivision can significantly reduce morbidity and mortality, and potential identification of specific gene mutations and advances in treatment options will hopefully provide guidance on detecting at-risk patients in the future. We present a case of a man with MDS-U (karyotype 46, XY, del (20) (q11.2q13.3) (20) with no detected <em>JAK2</em> <em>V617F</em> mutation), who in despite of appropriate evidenced based treatment, continued to exhibit refractory thrombocytopenia.

scholarly journals Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Federico Coccolini ◽  
◽  
Leslie Kobayashi ◽  
Yoram Kluger ◽  
Ernest E. Moore ◽  
...  
Keyword(s):  
Pediatric Trauma ◽  
Biliary Tree ◽  
Pancreatic Injury ◽  
Hemodynamic Instability ◽  
Anatomical Location ◽  
Trauma Patients ◽  
Associated Injuries ◽  
Management Guidelines ◽  
Pancreatic Injuries ◽  
Extrahepatic Biliary Tree

AbstractDuodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

An Immersed Porous Boundary Method for Computational Fluid Dynamics of Blood Flow in Aneurysms With Flow Diverters

2012 ◽  
Author(s):  
Viorel Mihalef ◽  
Puneet Sharma ◽  
Ali Kamen ◽  
Thomas Redel
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Blood Flow ◽  
Subarachnoid Hemorrhage ◽  
Cerebral Artery ◽  
Intracranial Aneurysms ◽  
Mortality Rates ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Flow Diverters

Intracranial aneurysms are pathological dilatations of a cerebral artery that may suffer rupture and lead to subarachnoid hemorrhage. Such a condition presents high morbidity and mortality rates for the patients concerned.

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