Local complications following pancreatic trauma

• Published in: Injury Vol. 40; no. 5; pp. 516 - 520
• Main Authors: Recinos, Gustavo, DuBose, Joseph J, Teixeira, Pedro G.R, Inaba, Kenji, Demetriades, Demetrios
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.05.2009; Elsevier
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Biological and medical sciences; Child; Complications; Diseases of the osteoarticular system; Drainage - adverse effects; Female; Humans; Injuries of the limb. Injuries of the spine; Injury Severity Score; Male; Medical sciences; Middle Aged; Multivariate Analysis; Orthopedics; Pancreas; Pancreas - injuries; Pancreatic Fistula - etiology; Pancreatic Pseudocyst - etiology; Registries; Retrospective Studies; Trauma; Traumas. Diseases due to physical agents; Treatment Outcome; Venae Cavae - injuries; Wounds, Nonpenetrating - complications; Wounds, Nonpenetrating - mortality; Wounds, Nonpenetrating - surgery; Wounds, Penetrating - complications; Wounds, Penetrating - mortality; Wounds, Penetrating - surgery; Young Adult; Pancreas; Complications; Trauma; Complication; Orthopedics
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2008.06.026

Abstract Background Major trauma to the pancreas is uncommon, but associated with significant overall morbidity and mortality. A vast majority of these adverse outcomes can be attributed to the presences of associated injuries. Among those patients who survive the initial injury, however, the subsequent development of pancreas-related complications represents a significant source of adverse outcomes. Methods and results A total of 257 patients admitted from January 1996 to April 2007 were identified from the trauma registry database at our institution. One hundred and eighty-three patients surviving more than 48 h after admission were selected for analysis. These patients were grouped according to the surgical management utilised to address their pancreatic injuries: either resection or operative drainage. After exclusion of patients with associated vascular injuries, those undergoing drainage had lower rate of associated hollow viscus injuries (51.9% vs. 69.9%; p = 0.016) and lower rates of associated solid organ injuries (44.2% vs. 70.9%; p ≤ 0.001). Patients undergoing drainage were noted to have a higher incidence of pseudocyst formation (19.5% vs. 9.0%; OR: 2.47, 95% CI, 0.92–6.67; p = 0.068), but lower hospital lengths of stay (18.7 ± 18.5 vs. 33.8 ± 63.5; p = 0.001). No difference in mortality was noted between the two populations (5.7% vs. 3.0%; p = 0.700). After multivariate analysis pseudocyst formation was the only complication that proved different between the two management groups, with patients undergoing operative drainage more commonly developing this adverse sequela (OR: 2.93, 95% CI, 1.02–8.36; p = 0.041). Conclusions In the absence of vascular injury, the choice of surgical management did not affect adjusted mortality or the overall occurrence of pancreas-related complications. Individuals treated with operative drainage alone, however, were significantly more likely to develop a post-operative pseudocyst than their resectional counterparts.