Pancreatic Trauma; 3 Years Experience at Allied Hospital, Faisalabad

Abstract

Introduction: Pancreatic injuries remain a clinical enigma. Minor injuries are easy to treat but if missed are associated with significant morbidity & mortality. Blunt trauma to upper abdomen is often associated with pancreatic injury. Isolated injury to pancreas is rare. There are different protocols of managing the pancreatic trauma. In this article we are presenting different cases of pancreatic trauma managed by us according to severity of injury. Objectives: 1.To define comonest mode of presentation of patients with pancreatic trauma. 2. To suggest appropriate investigations in suspected pancreatic injuries. 3. To suggest the treatment strategy in different types of pancreatic injuries. Study Design: Descriptive prospective study conducted in Surgical Unit III, Allied Hospital Faisalabad from Feb 2008 to Dec 2011. Results: Forty eight (48) patients (10 children, 38 adults) included with   median age 11 and 35 respectively. Male to female ratio 5:1. Blunt trauma was mechanism of injury in 62.5% of cases mainly due to road traffic accident.  Serum amylase was raised in 59% of cases. CT scan was diagnostic in most of the hemodynamically stable patients. Roux-en-Y Pancreatojejunostmy, distal pancreatectomy and Whipple’s procedure were performed depending upon the grade of injury. Postoperative pancreatic fistula formed in 26% of cases, which was managed conservatively. Overall mortality was 37.5%. Conclusion: Pancreatic injuries commonly occur due to blunt abdominal trauma. High index of clinical suspicion is required for timely decion making. CT Scan is useful in hemodynamically stable patients. Early diagnosis and timely management according to the severity of injury improves morbidity and mortality