SpringerLink
Log in

Major pancreatic duct continuity is the crucial determinant in the management of blunt pancreatic injury: a pancreatographic classification

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

To evaluate the management and outcomes of blunt pancreatic injuries based on the integrity of the major pancreatic duct (MPD).

Methods

Between August 1996 and August 2015, 35 patients with blunt pancreatic injuries underwent endoscopic retrograde pancreatography (ERP). Medical charts were retrospectively reviewed for demography, ERP timing, imaging findings, management, and outcome.

Results

Of the 35 patients, 21 were men and 14 were women, with ages ranging from 11 to 70 years. On the basis of the ERP findings, we propose a MPD injury classification as follows: class 1 indicates normal MPD; class 2, partial injury with intact MPD continuity; and class 3, complete injury with disrupted MPD continuity. Both classes 2 and 3 are subdivided into classes a, b, and c, which represent the pancreatic tail, body, and head, respectively. In this report, 14 cases belonged to class 1, 10 belonged to class 2, and 11 belonged to class 3. Of the 14 patients with class 1 injuries, 10 underwent nonsurgical treatment and 4 underwent pancreatic duct stenting. Of the 10 patients with class 2 injuries, 4 underwent nonsurgical treatment and 6 underwent pancreatic duct stenting. Two of the 11 patients with class 3 injuries underwent pancreatic duct stenting; one in the acute stage developed sepsis that led to death even after converting to distal pancreatectomy plus splenectomy. Of the 11 patients with class 3 injuries, spleen-preserving distal pancreatectomy was performed in 6, distal pancreatectomy plus splenectomy in 2, and Roux-en-Y pancreaticojejunostomy after central pancreatectomy in 2. The overall pancreatic-related morbidity rate was 60% and the mortality rate was 2.8%.

Conclusion

Based on our experience, class 1 and 2 injuries could be treated by nonsurgical means and pancreatic duct stenting could be an adjunctive therapy in class 2b and 2c injuries. Operation is warranted in class 3 injuries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Jurkovich GJ, Carrico CJ (1990) Pancreatic trauma. Surg Clin North Am 70:575–593

    Article  CAS  PubMed  Google Scholar 

  2. Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL (2004) Management of blunt major pancreatic injury. J Trauma 56:774–778

    Article  PubMed  Google Scholar 

  3. Moore EE, Cogbill T, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, McAninch JW, Pachter HL, Shackford SR, Trafton PG (1990) Organ injury scale II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma 30:1427–1429

    Article  CAS  PubMed  Google Scholar 

  4. Wisner DH, Wold RL, Frey CF (1990) Diagnosis and treatment of pancreatic injuries: an analysis of management principles. Arch Surg 125:1109–1113

    Article  CAS  PubMed  Google Scholar 

  5. Patton JH Jr, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, Fabian TC (1997) Pancreatic trauma: a simplified management guideline. J Trauma 43:234–241

    Article  PubMed  Google Scholar 

  6. Biffl WL, Moore EE, Croce M, Davis JW, Coimbra R, Karmy-Jones R, McIntyre RC Jr, Moore FA, Sperry J, Malhotra A, Feliciano D (2013) Western Trauma Association critical decisions in trauma: management of pancreatic injuries. J Trauma Acute Care Surg 75:941–946

    Article  PubMed  Google Scholar 

  7. Wong YC, Wang LJ, Fang JF, Lin BC, Ng CJ, Chen RJ (2008) Multidetector-row computed tomography (CT) of blunt pancreatic injuries: can contrast-enhanced multiphasic CT detect pancreatic duct injuries? J Trauma 64:666–672

    Article  PubMed  Google Scholar 

  8. Belohlavek D, Merkle P, Probst M (1978) Identification of traumatic rupture of the pancreatic duct by endoscopic retrograde pancreatography. Gastrointest Endosc 24:255–256

    Article  CAS  PubMed  Google Scholar 

  9. Barkin JS, Ferstenburg RM, Panullo W, Manten HD, Davis RC Jr (1988) Endoscopic retrograde cholangiopancreatography in pancreatic trauma. Gastrointest Endosc 34:102–105

    Article  CAS  PubMed  Google Scholar 

  10. Bhasin DK, Rana SS, Rao C, Gupta R, Verma GR, Kang M, Nagi B, Singh K (2012) Endoscopic management of pancreatic injury due to abdominal trauma. J Pancreas 13:187–192

    Google Scholar 

  11. Takishima T, Hirata M, Kataoka Y, Asari Y, Sato K, Ohwada T, Kakita A (2000) Pancreatographic classification of pancreatic ductal injuries caused by blunt injury to the pancreas. J Trauma 48:745–752

    Article  CAS  PubMed  Google Scholar 

  12. Thomson DA, Krige JE, Thomson SR, Bornman PC (2014) The role of endoscopic retrograde pancreatography in pancreatic trauma: a critical appraisal of 48 patients treated at a tertiary institution. J Trauma Acute Care Surg 76:1362–1366

    Article  PubMed  Google Scholar 

  13. Kim HS, Lee DK, Kim IW, Baik SK, Kwon SO, Park JW, Cho NC, Rhoe BS (2001) The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc 54:49–55

    Article  CAS  PubMed  Google Scholar 

  14. Whittwell AE, Gomez GA, Byers P, Kreis DJ Jr, Manten H, Casillas VJ (1989) Blunt pancreatic trauma: prospective evaluation of early endoscopic retrograde pancreatography. South Med 82:586–591

    Article  CAS  Google Scholar 

  15. Delcenserie R, Barthet MA, Yzet T, Grimaud JC, Dupas JL (2001) Endoscopic retrograde pancreatography in diagnosis and treatment of pancreatic trauma. Gastrointest Endosc 53:AB138

    Google Scholar 

  16. Houben CH, Ade-Ajayi N, Patel S, Kane P, Karani J, Devlin J, Harrison P, Davenport M (2007) Traumatic pancreatic duct injury in children: minimally invasive approach to management. J Pediatr Surg 42:629–635

    Article  PubMed  Google Scholar 

  17. Wind P, Tiret E, Cunningham C, Frileux P, Cugnenc P, Parc R (1999) Contribution of endoscopic retrograde pancreatography in management of complications following distal pancreatic trauma. Am Surg 65:777–783

    CAS  PubMed  Google Scholar 

  18. Wood JH, Partrick DA, Bruny JL, Sauaia A, Moulton SL (2010) Operative vs nonoperative management of blunt pancreatic trauma in children. J Pediatr Surg 45:401–406

    Article  PubMed  Google Scholar 

  19. Rogers SJ, Cello JP, Schecter WP (2010) Endoscopic retrograde cholangiography in patients with pancreatic trauma. J Trauma 68:538–544

    Article  PubMed  Google Scholar 

  20. Keil R, Drabek J, Lochmannova J, Stovicek J, Rygl M, Snajdauf J, Hlava S (2016) What is the role of endoscopic retrograde cholangiopancreatography in assessing traumatic rupture of the pancreatic in children? Scand J Gastroenterol 51:218–224

    Article  PubMed  Google Scholar 

  21. Coelho DE, Ardengh JC, Carbalo MT, de Lina-Filho ER, Baron TH, Coelho JF (2011) Clinicopathologic characteristics and endoscopic treatment of post-traumatic pancreatic pseudocysts. Pancreas 40:469–473

    Article  PubMed  Google Scholar 

  22. Cheon YK, Cho KB, Watkins JL, Mchenry L, Fogel EL, Sherman S, Lehman GA (2007) “Frequency and severity of post-ERCP pancreatitis correlated with extent of pancreatic ductal opacification. Gastrointest Endosc 65:385–393

    Article  PubMed  Google Scholar 

  23. Lin BC, Liu NJ, Fang JF, Kao YC (2006) Long-term results of endoscopic stent in the management of blunt major pancreatic duct injury. Surg Endosc 20:1551–1555

    Article  PubMed  Google Scholar 

  24. Lin BC, Fang JF, Wong YC, Liu NJ (2007) Blunt pancreatic trauma and pseudocyst: management of major pancreatic duct injury. Injury 38:588–593

    Article  PubMed  Google Scholar 

  25. Ikenberr SO, Sherman S, Hawes RH, Smith M, Lehman GA (1994) The occlusion rate of pancreatic stents. Gastrointest Endosc 40:611–613

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Miss Shu-Fang Huang for her statistical assistance.

Author information

Authors and Affiliations

  1. Division of Trauma & Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kwei-Shan, Tao-Yuan City, 333, Taiwan, ROC

    Being-Chuan Lin & Yu-Pao Hsu

  2. Division of Emergency and Critical Care Radiology, Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC

    Yon-Cheong Wong & Cheng-Hsien Wu

  3. Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan, ROC

    Ray-Jade Chen

  4. Department of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC

    Nai-Jen Liu

  5. Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Tao-Yuan City, Taiwan, ROC

    Tsann-Long Hwang

Authors
  1. Being-Chuan Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yon-Cheong Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ray-Jade Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nai-Jen Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cheng-Hsien Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tsann-Long Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yu-Pao Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Being-Chuan Lin.

Ethics declarations

Disclosures

Drs Being-Chuan Lin, Yon-Cheong Wong, Ray-Jade Chen, Nai-Jen Liu, Cheng-Hsien Wu, Tsann-Long Hwang, and Yu-Pao Hsu have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lin, BC., Wong, YC., Chen, RJ. et al. Major pancreatic duct continuity is the crucial determinant in the management of blunt pancreatic injury: a pancreatographic classification. Surg Endosc 31, 4201–4210 (2017). https://doi.org/10.1007/s00464-017-5478-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-017-5478-0

Keywords

Search

Navigation