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Prognosis and treatment of pancreaticoduodenal traumatic injuries: which factors are predictors of outcome?
Author(s) -
Antonacci Nicola,
Di Saverio Salomone,
Ciaroni Valentina,
Biscardi Andrea,
Giugni Aimone,
Cancellieri Francesco,
Coniglio Carlo,
Cavallo Piergiorgio,
Giorgini Eleonora,
Baldoni Franco,
Gordini Giovanni,
Tugnoli Gregorio
Publication year - 2011
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1007/s00534-010-0329-6
Subject(s) - medicine , surgery , duodenum , anastomosis , pancreatic injury , blunt , pancreas , penetrating trauma , retrospective cohort study , fibrous joint , pancreaticoduodenectomy , blunt trauma , abdominal trauma , general surgery , pancreatitis , resection
Background/purpose Abdominal trauma rarely causes injuries involving the duodenum and pancreas. Associated injuries occur in 46% of all pancreatic injuries. The morbidity and mortality of pancreaticoduodenal injuries remain high. Methods The present study is a retrospective review of our experience from 1989 to 2008 in the surgical treatment of traumatic pancreaticoduodenal injuries. Mortality, morbidity, prognostic factors, and the value of surgical techniques were analyzed. Results In our level I Trauma Center, between 1989 and 2008, 55 patients had a pancreaticoduodenal injury. In 68.5% of cases pancreatic injuries were found, 20.4% had duodenal injury, and 11.1% suffered combined pancreaticoduodenal injuries; 85.3% of the patients had blunt abdominal trauma, while 14.9% had penetrating injuries. We treated 78.1% of the patients with external drainage and/or simple suture; distal pancreatectomy was performed in 9% of cases and duodenal resection with anastomosis (3.7%) and diversion procedures (3.7%) were performed in an equal number of patients. Age, American Association for the Surgery of Trauma (AAST) grade, organ involved, hemodynamic status, intraoperative cardiac arrest, and operative time remained strongly predictive of mortality on multivariate analysis. The AAST grade represented, on multivariate analysis, the only independent prognostic factor predictive of overall morbidity. In the past decade we have used feeding jejunostomy more frequently, with a reduction of mortality and operating time, due also to a better approach from a dedicated trauma team. Conclusions Optimal management and better outcome of pancreaticoduodenal injuries seem to be associated with shorter operative time, and with simple and fast damage control surgery (DCS), in contrast to definitive surgical procedures.