Management strategies of grade I, II, III blunt pancreatic injuries: our center’s experience

Background
Pancreatic injuries are rare among solid organ injuries. Blunt pancreatic injuries are classified according to the American Association for the Surgery of Trauma. According to the American Association for the Surgery of Trauma scale, grade I and II injuries are generally managed by conservative treatment, whereas grades III, IV, and V typically require surgical treatment. Traumatic pancreatic injuries are characterized by high morbidity and mortality rates.
Patient and methods
Grade I, II, II pancreatic injury patients were included in this study and grade IV patients were excluded together with the pediatric age group. Patients of this study were divided into operative groups, where surgical exploration with drainage and/or pancreatic resection or necrosectomy and continuous saline lavage was done with application of hemostatic sealant sheets over the raw surface of pancreas and conservative groups, where conservative measures were carried out.
Results
According to The American Association for the Surgery of Trauma (AAST) grade I, seven patients, grade II, eight patients grade III two patients, 10 patients underwent operative intervention, drainage and/or pancreatic resection with continuous saline lavage, and application of hemostatic sealant material when needed. One patient developed pancreatic pseudocyst. Seven patients underwent conservative measures, with two patients having developed pseudocyst and one patient developing pancreatic fistula.
Conclusion
Operative intervention of grade II, III injuries with application of continuous saline lavage, and application of hemostatic sealant material when needed helps to decrease complications.