TY - JOUR
T1 - Distal pancreatectomy for trauma
T2 - A multicenter experience
AU - Cogbill, Thomas H.
AU - Moore, Ernest E.
AU - Morris, John A.
AU - Hoyt, David B.
AU - Jurkovich, Gregory J.
AU - Mucha, Peter
AU - Ross, Steven E.
AU - Feliciano, David V.
AU - Shackford, Steven R.
AU - Landercasper, Jeffrey
AU - Moore, Frederick A.
AU - Vanaalst, John A.
AU - Davis, James W.
AU - Offner, Patrick J.
AU - Rhodes, Michael
AU - O'malley, Keith F.
AU - Swierzewski, Mark J.
AU - Schmoker, Joseph D.
AU - Strutt, Pamela J.
PY - 1991/12
Y1 - 1991/12
N2 - During a 5-year period, 74 patients with pancreatic injuries were managed by distal pancreatic resection at nine referral trauma centers. Patient ages ranged from 4 to 72 years. Injury mechanism was blunt trauma in 34 (46%) patients, gunshot wound in 27 (36%), stab wound in 11 (15%), and shotgun blast in two (3%). There were 19 class II, 50 class III, and 5 class IV pancreatic injuries. The resection comprised up to 33% of the pancreas in 21 (28%) patients, from 34% to 66% in 45 (61%), and greater than 67% in eight (11%). The pancreatic resection margin was closed with staples in 44 (59%), silk sutures in 20 (27%), and polypropylene sutures in eight (11%). Of 32 patients in whom the spleen was uninjured, the spleen was left intact in 17 (53%). There were nine (12%) deaths. The cause of death was irreversible shock in three patients, multiple organ failure in five, and severe head injury in one. Pancreas-related complications occurred in 32 (45%) of 71 patients who survived the initial operation. Intra-abdominal abscess developed in 24 patients; 11 were managed by percutaneous drainage alone. Pancreatic fistula developed in 10 patients; eight closed spontaneously from 6 to 54 days. Other pancreas-related morbidity included pancreatitis (6), pseudocyst (2), and hemorrhage (2). Exocrine insufficiency was not evident in any patient and diet-controlled hyperglycemia occurred in one individual following 80% pancreatic resection. We conclude: (1) distal pancreatectomy can be safely performed without concomitant splenectomy; (2) pancreas-related morbidity is frequent after pancreatic resection for trauma, regardless of method of pancreatic closure; and (3) endocrine and exocrine insufficiency are rare after distal pancreatectomy for trauma.
AB - During a 5-year period, 74 patients with pancreatic injuries were managed by distal pancreatic resection at nine referral trauma centers. Patient ages ranged from 4 to 72 years. Injury mechanism was blunt trauma in 34 (46%) patients, gunshot wound in 27 (36%), stab wound in 11 (15%), and shotgun blast in two (3%). There were 19 class II, 50 class III, and 5 class IV pancreatic injuries. The resection comprised up to 33% of the pancreas in 21 (28%) patients, from 34% to 66% in 45 (61%), and greater than 67% in eight (11%). The pancreatic resection margin was closed with staples in 44 (59%), silk sutures in 20 (27%), and polypropylene sutures in eight (11%). Of 32 patients in whom the spleen was uninjured, the spleen was left intact in 17 (53%). There were nine (12%) deaths. The cause of death was irreversible shock in three patients, multiple organ failure in five, and severe head injury in one. Pancreas-related complications occurred in 32 (45%) of 71 patients who survived the initial operation. Intra-abdominal abscess developed in 24 patients; 11 were managed by percutaneous drainage alone. Pancreatic fistula developed in 10 patients; eight closed spontaneously from 6 to 54 days. Other pancreas-related morbidity included pancreatitis (6), pseudocyst (2), and hemorrhage (2). Exocrine insufficiency was not evident in any patient and diet-controlled hyperglycemia occurred in one individual following 80% pancreatic resection. We conclude: (1) distal pancreatectomy can be safely performed without concomitant splenectomy; (2) pancreas-related morbidity is frequent after pancreatic resection for trauma, regardless of method of pancreatic closure; and (3) endocrine and exocrine insufficiency are rare after distal pancreatectomy for trauma.
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U2 - 10.1097/00005373-199112000-00006
DO - 10.1097/00005373-199112000-00006
M3 - Article
C2 - 1749029
AN - SCOPUS:0026334471
SN - 0022-5282
VL - 31
SP - 1600
EP - 1606
JO - Journal of Trauma - Injury, Infection and Critical Care
JF - Journal of Trauma - Injury, Infection and Critical Care
IS - 12
ER -