Novel Surgical Technique for Traumatic Pancreatic Rupture
Novel Surgical Technique for Traumatic Pancreatic Rupture
Introduction: Complete pancreatic rupture is a rare injury. The typical mechanism by which this occurs is overstretching of the pancreas across the vertebral column during blunt abdominal trauma. The management of this injury depends on the location and extent of the injury.
Case presentation: A 45-year-old Caucasian woman presented with blunt abdominal trauma after she fell onto the end of a handlebar during a bicycle accident. She arrived in the emergency room with stable vital signs and an isolated bruise just above the umbilicus. A computed tomography scan revealed a complete rupture of the pancreas, just ventral to her superior mesenteric vein, and an accompanying hematoma but no additional injuries. An emergency laparotomy was performed; the head of the pancreas was oversewn with interrupted sutures and this was followed by a two-layer pancreaticojejunostomy with the tail of the pancreas. The recovery after surgery was completely uneventful.
Conclusions: Isolated complete pancreatic rupture is a rare injury that can be managed with complete organ preservation. The combination of suturing the pancreatic head and two-layer pancreaticojejunostomy with the pancreatic tail is a feasible technique to manage this condition.
Blunt abdominal trauma is typically followed by laceration of the spleen, liver, or mesentery of the intestine. Such trauma may also cause pancreatic rupture, although this happens in less than 1% of cases. Isolated pancreatic rupture after blunt abdominal trauma is even rarer, and very few case reports (for example,) have been published. Pancreatic rupture may be classified by the Lucas classification from grade I to III (I: superficial contusion with minimal damage; II: deep laceration or transection of the left portion of the pancreas; III: injury of the pancreatic head). Management of pancreatic rupture is controversial. A key question is whether the pancreatic duct was left intact or not. In general, treatment with external drainage is recommended when the duct is intact, whereas distal pancreatectomy is typically suggested for lesions to the main duct in the pancreatic body or tail. Complete rupture of the pancreas is most easily and safely managed by oversewing the proximal part of the pancreas and removing the distal portion (that is, the pancreatic tail). Distal pancreatectomy, however, involves the risk of subsequent endocrine dysfunction (that is, reduced glucose tolerance or diabetes in up to 50% of patients). An alternative that allows organ preservation is to drain the pancreatic tail into the stomach. Here, we present a case of a middle-aged woman with an isolated complete pancreatic rupture that was managed successfully by a special surgical anastomotic technique that has not been reported for the treatment of pancreatic rupture.
Abstract and Introduction
Abstract
Introduction: Complete pancreatic rupture is a rare injury. The typical mechanism by which this occurs is overstretching of the pancreas across the vertebral column during blunt abdominal trauma. The management of this injury depends on the location and extent of the injury.
Case presentation: A 45-year-old Caucasian woman presented with blunt abdominal trauma after she fell onto the end of a handlebar during a bicycle accident. She arrived in the emergency room with stable vital signs and an isolated bruise just above the umbilicus. A computed tomography scan revealed a complete rupture of the pancreas, just ventral to her superior mesenteric vein, and an accompanying hematoma but no additional injuries. An emergency laparotomy was performed; the head of the pancreas was oversewn with interrupted sutures and this was followed by a two-layer pancreaticojejunostomy with the tail of the pancreas. The recovery after surgery was completely uneventful.
Conclusions: Isolated complete pancreatic rupture is a rare injury that can be managed with complete organ preservation. The combination of suturing the pancreatic head and two-layer pancreaticojejunostomy with the pancreatic tail is a feasible technique to manage this condition.
Introduction
Blunt abdominal trauma is typically followed by laceration of the spleen, liver, or mesentery of the intestine. Such trauma may also cause pancreatic rupture, although this happens in less than 1% of cases. Isolated pancreatic rupture after blunt abdominal trauma is even rarer, and very few case reports (for example,) have been published. Pancreatic rupture may be classified by the Lucas classification from grade I to III (I: superficial contusion with minimal damage; II: deep laceration or transection of the left portion of the pancreas; III: injury of the pancreatic head). Management of pancreatic rupture is controversial. A key question is whether the pancreatic duct was left intact or not. In general, treatment with external drainage is recommended when the duct is intact, whereas distal pancreatectomy is typically suggested for lesions to the main duct in the pancreatic body or tail. Complete rupture of the pancreas is most easily and safely managed by oversewing the proximal part of the pancreas and removing the distal portion (that is, the pancreatic tail). Distal pancreatectomy, however, involves the risk of subsequent endocrine dysfunction (that is, reduced glucose tolerance or diabetes in up to 50% of patients). An alternative that allows organ preservation is to drain the pancreatic tail into the stomach. Here, we present a case of a middle-aged woman with an isolated complete pancreatic rupture that was managed successfully by a special surgical anastomotic technique that has not been reported for the treatment of pancreatic rupture.
