Ann Surg Treat Res.  2018 Jul;95(1):29-36. 10.4174/astr.2018.95.1.29.

Pancreatic fistula and mortality after surgical management of pancreatic trauma: analysis of 81 consecutive patients during 11 years at a Korean trauma center

• Kang WS
• Park YC
• Jo YG
• Kim JC

• KMID: 2414450
• DOI: http://doi.org/10.4174/astr.2018.95.1.29

Abstract

PURPOSE
Pancreatic trauma is infrequent because of its central, deep anatomical position. This contributes to a lack of surgeon experience and many debates exist about its standard care. This study aimed to investigate the postoperative pancreatic fistula (POPF) and mortality of pancreatic trauma after operation.
METHODS
We reviewed records in the trauma registry of our institution submitted from January 2006 to December 2016. The grade of pancreatic injury, surgical management, morbidity, mortality, and other clinical variables included in the analyses.
RESULTS
Data from a total of 26,072 trauma patients admitted to the Emergency Department were analyzed. Pancreatic trauma was observed in 114 of these patients (0.44%). Laparotomy was performed in 81 patients (2 pan creatico duodenectomies, 2 pancreaticogastrostomies, peripancreatic drainage in 41 patients, distal pancreatectomies in 34 patients, and 9 patients who underwent surgery for damage control). The incidence of POPF was 38.3%. The overall mortality was 8.8% (7 of 81). In multivariate analysis, pancreas injury grade IV (≥4) (adjusted odds ratio [AOR], 4.071; P = 0.029) and preoperative peritonitis signs (AOR, 2.903; P = 0.039) were independent risk factors for POPF. All patients who died had also another major abdominal injury (≥grade 3). Multiorgan failure was a major cause of death (6 of 7, 85.7%). The mortality rate of isolated pancreas injury was 0%.
CONCLUSION
The pancreas injury grade and preoperative peritonitis were significant risk factors of POPF. The mortality rate of isolated pancreatic trauma was very low.

Keyword

Pancreas; Trauma; Pancreatic fistulas; Mortality

MeSH Terms

Abdominal Injuries
Cause of Death
Drainage
Emergency Service, Hospital
Humans
Incidence
Intraoperative Complications
Laparotomy
Mortality*
Multivariate Analysis
Odds Ratio
Pancreas
Pancreatectomy
Pancreatic Fistula*
Peritonitis
Risk Factors
Trauma Centers*

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