A Case of Organ Injury Scaling of the American Association for the Surgery of Trauma Grade IV Pancreatic Injury in a Patient with Pancreaticoduodenectomy after Diagnosis of Main Pancreatic Duct Injury by Endoscopic Retrograde Pancreatography

• Published in: Toho Journal of Medicine Vol. 10; no. 2; pp. 54 - 60
• Main Authors: Masaaki Inoue, Koji Asai, Kenta Shigeta, Ryutaro Watanabe, Hodaka Moriyama, Osahiko Hagiwara, Sayaka Nagao, Toshiyuki Enomoto, Takaharu Kiribayashi, Nobue Futawatari, Takuya Nagata, Manabu Watanabe, Toshiaki Oharaseki, Yoshihisa Saida
• Format: Journal Article
• Language: Japanese
• Published: The Medical Society of Toho University 01.06.2024
• ISSN: 2189-1990

[ABSTRACT] : In a basketball game, a 16-year-old boy lost his balance in the air and fell to the floor on his abdomen. Computed tomography revealed a low-density area of the pancreatic head. Endoscopic retrograde pancreatography revealed main pancreatic duct (MPD) injury and contrast medium leakage. Thus, he was diagnosed with Organ Injury Scaling of the American Association for the Surgery of Trauma grade IV pancreatic injury. Pancreaticoduodenectomy was performed. Although chylous ascites and acute stress disorder occurred, the patient was managed conservatively and discharged on postoperative day 33. Surgery is now commonly performed for MPD injury, but recently, successful nonoperative management (NOM) cases have been reported. There is no consensus on the exact treatment approach, which includes resection, drainage, or NOM, for grade IV pancreatic injury. NOM is not always the best treatment approach, and selecting the appropriate diagnostic method and surgical technique for each case is important.