Conservative management of complete traumatic pancreatic body transection; A case report. (2020)

• Record Type: Journal Article
• Authors: Duggan, W.; Hannan, E.; Brosnan, C.; O'Sullivan, S.; Conlon, K.
• Is Part Of: International journal of surgery case reports. Volume 71(2020)
• Page Start: 222
• Page End: 224
• Publication Date: 2020
• Subjects: Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2020.05.011
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Pancreatic trauma is associated with considerable morbidity and mortality. Traditionally, cases that involved injury to the pancreatic duct were almost always managed operatively. Much of the morbidity and mortality associated is related to operative complications. This case highlights that where possible, in instances where there is no bile leak or active haemorrhage, a conservative management approach may be safe and effective. Abstract: Introduction: Isolated pancreatic body transection secondary to blunt abdominal trauma is a very rare injury associated with poor outcomes. Almost all previously reported cases were managed by emergency distal pancreatectomy, which is associated with high morbidity and mortality. To our knowledge, this is the first reported case of complete transection of the pancreas at the body that was successfully treated by conservative management in an adult patient. Presentation of case: A 19-year-old male was found to have complete transection of the pancreatic body on computed tomography (CT) following blunt force abdominal trauma. Given that he was haemodynamically stable without evidence of haemorrhage or bile leakage on imaging, a trial of conservative management was initiated. He remained well through his admission, gradually improving clinically and biochemically with stable appearances on serial imaging. He remains asymptomatic as of six months since discharge from the hospital and continues to be monitored in the outpatient setting. Discussion: Management of pancreatic trauma with ductal injury has typically been with emergency distal pancreatectomy, which is associated with high morbidity and mortality. The decision to operate should not be purely based on radiological findings, and should take into account clinical status, haemodynamic stability, coexisting injuries and evidence of active haemorrhage or bile leak. Conclusion: In select cases, it is reasonable to trial conservative management in isolated traumatic pancreatic body fracture by means of close clinical observation and serial imaging. This may allow the patient to avoid a high-risk emergency distal pancreatectomy.