Distal pancreatectomy for trauma: A multicenter experience

Thomas H. Cogbill, Ernest E. Moore, John A. Morris, David B. Hoyt, Gregory J. Jurkovich, Peter Mucha, Steven E. Ross, David V. Feliciano, Steven R. Shackford, Jeffrey Landercasper, Frederick A. Moore, John A. Vanaalst, James W. Davis, Patrick J. Offner, Michael Rhodes, Keith F. O'Malley, Mark J. Swierzewski, Joseph D. Schmoker, Pamela J. Strutt

Research output: Contribution to journalArticle

132 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1600-1606
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume31
Issue number12
DOIs
StatePublished - Jan 1 1991
Externally publishedYes

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Pancreatectomy
Wounds and Injuries
Pancreas
Sutures
Spleen
Abdominal Abscess
Stab Wounds
Morbidity
Pancreatic Fistula
Gunshot Wounds
Silk
Multiple Organ Failure
Polypropylenes
Trauma Centers
Firearms
Splenectomy
Craniocerebral Trauma
Hyperglycemia
Pancreatitis
Drainage

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

Cogbill, T. H., Moore, E. E., Morris, J. A., Hoyt, D. B., Jurkovich, G. J., Mucha, P., ... Strutt, P. J. (1991). Distal pancreatectomy for trauma: A multicenter experience. Journal of Trauma - Injury, Infection and Critical Care, 31(12), 1600-1606. https://doi.org/10.1097/00005373-199112000-00006

Distal pancreatectomy for trauma : A multicenter experience. / Cogbill, Thomas H.; Moore, Ernest E.; Morris, John A.; Hoyt, David B.; Jurkovich, Gregory J.; Mucha, Peter; Ross, Steven E.; Feliciano, David V.; Shackford, Steven R.; Landercasper, Jeffrey; Moore, Frederick A.; Vanaalst, John A.; Davis, James W.; Offner, Patrick J.; Rhodes, Michael; O'Malley, Keith F.; Swierzewski, Mark J.; Schmoker, Joseph D.; Strutt, Pamela J.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 31, No. 12, 01.01.1991, p. 1600-1606.

Research output: Contribution to journalArticle

Cogbill, TH, Moore, EE, Morris, JA, Hoyt, DB, Jurkovich, GJ, Mucha, P, Ross, SE, Feliciano, DV, Shackford, SR, Landercasper, J, Moore, FA, Vanaalst, JA, Davis, JW, Offner, PJ, Rhodes, M, O'Malley, KF, Swierzewski, MJ, Schmoker, JD & Strutt, PJ 1991, 'Distal pancreatectomy for trauma: A multicenter experience', Journal of Trauma - Injury, Infection and Critical Care, vol. 31, no. 12, pp. 1600-1606. https://doi.org/10.1097/00005373-199112000-00006
Cogbill, Thomas H. ; Moore, Ernest E. ; Morris, John A. ; Hoyt, David B. ; Jurkovich, Gregory J. ; Mucha, Peter ; Ross, Steven E. ; Feliciano, David V. ; Shackford, Steven R. ; Landercasper, Jeffrey ; Moore, Frederick A. ; Vanaalst, John A. ; Davis, James W. ; Offner, Patrick J. ; Rhodes, Michael ; O'Malley, Keith F. ; Swierzewski, Mark J. ; Schmoker, Joseph D. ; Strutt, Pamela J. / Distal pancreatectomy for trauma : A multicenter experience. In: Journal of Trauma - Injury, Infection and Critical Care. 1991 ; Vol. 31, No. 12. pp. 1600-1606.
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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.

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