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CME

Pancreatic Trauma - Emergency Management

General Information

General InformationGeneral Information

Background

  • Pancreatic injuries are uncommon but are associated with significant morbidity and mortality given the significant mechanism required to injure the pancreas
  • Diagnosing pancreatic injuries can be challenging due to the delayed onset of signs and symptoms and limitations of available diagnostic modalities
  • Early diagnosis is key for optimal management1

Anatomy

  • Pancreas is fixed and mostly retroperitoneal, except the tail
    • Head: adjacent to duodenum
    • Uncinate process: extends inferiorly from the head, superior to superior mesenteric vessels
    • Neck: narrow area demarcating head from body
    • Body: portion of pancreas behind stomach
    • Tail: adjacent to spleen in the splenorenal ligament
  • For both penetrating and blunt pancreatic injury, presence of main pancreatic ductal injury is the major determinant of morbidity1
  • Blood supply
    • Superior pancreaticoduodenal artery from gastroduodenal artery
    • Inferior pancreaticoduodenal artery from superior mesenteric artery
    • Pancreatic branches of the splenic artery

Etiology

  • Large portion of pancreatic injuries (up to two-thirds) are due to penetrating trauma2
  • Blunt trauma classically occurs by the pancreas being crushed between the anterior abdominal wall and vertebral column
    • Examples: handlebar injuries in bike accidents, steering wheel injuries in motor vehicle collisions, or assaultive trauma to the epigastrium
    • More commonly body, then head, then tail

Epidemiology

  • Pancreatic injuries occur in 1%-5% of blunt abdominal trauma and 12% of penetrating trauma3
  • Mortality for pancreatic injuries ranges from 9% to 34% but only 5% of pancreatic injuries are directly related to fatality4
  • Most are associated with concurrent organ injuries
    • Over 75% of penetrating pancreatic injuries are associated with major abdominal vascular injuries5
    • Blunt pancreatic injuries are also associated with solid organ and hollow viscus injuries

References

References

General references used

  1. Potoka DA, Gaines BA, Leppäniemi A, Peitzman AB. Management of blunt pancreatic trauma: what's new? Eur J Trauma Emerg Surg. 2015 Jun;41(3):239-50
  2. Akhrass R, Yaffe MB, Brandt CP, Reigle M, Fallon WF Jr, Malangoni MA. Pancreatic trauma: a ten-year multi-institutional experience. Am Surg. 1997 Jul;63(7):598-604
  3. Fisher M, Brasel K. Evolving management of pancreatic injury. Curr Opin Crit Care. 2011 Dec;17(6):613-7
  4. Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, Singh K. Pancreatic trauma: a concise review. World J Gastroenterol. 2013 Dec 21;19(47):9003-11
  5. Cirillo RL Jr, Koniaris LG. Detecting blunt pancreatic injuries. J Gastrointest Surg. 2002 Jul-Aug;6(4):587-98
  6. Mahajan A, Kadavigere R, Sripathi S, Rodrigues GS, Rao VR, Koteshwar P. Utility of serum pancreatic enzyme levels in diagnosing blunt trauma to the pancreas: a prospective study with systematic review. Injury. 2014 Sep;45(9):1384-93
  7. Phelan HA, Velmahos GC, Jurkovich GJ, et al. An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma. 2009 Mar;66(3):641-6
  8. Garvey EM, Haakinson DJ, McOmber M, Notrica DM. Role of ERCP in pediatric blunt abdominal trauma: a case series at a level one pediatric trauma center. J Pediatr Surg. 2015 Feb;50(2):335-8
  9. Kobayashi L, Costantini TW, Coimbra R. Hypovolemic shock resuscitation. Surg Clin North Am. 2012 Dec;92(6):1403-23
  10. Stahel PF, Smith WR, Moore EE. Current trends in resuscitation strategy for the multiply injured patient. Injury. 2009 Nov;40 Suppl 4:S27-35
  11. Degiannis E, Glapa M, Loukogeorgakis SP, Smith MD. Management of pancreatic trauma. Injury. 2008 Jan;39(1):21-9
  12. Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg. 1991 Oct;78(10):1196-202
  13. Recinos G, DuBose JJ, Teixeira PG, Inaba K, Demetriades D. Local complications following pancreatic trauma. Injury. 2009 May;40(5):516-20

DynaMed Editorial Process

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  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T906326, Pancreatic Trauma - Emergency Management; [updated 2018 Nov 30, cited place cited date here]. Available from https://www.dynamed.com/topics/dmp~AN~T906326. Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.

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