SURGICAL TREATMENT OF PANCREATIC TRAUMA: DELINATION OF DETERMINANTS OF OUTCOME

Abstract: Pancreatic injuries are delayed in diagnosis, associated both with other injuries and autodigestion of both 
pancreatic tissue and surrounding structures. Aim of the study was to evaluate different lines of surgical treatment of 
pancreatic trauma and to delinate determinants of outcome. 
The study was done on 35 patients, with pancreatic trauma 28 males and 7 females, their age ranged from 6 years – 55 
years with a mean age of 27.5 years at Mansoura University Hospital and Emergency Hospital, Faculty of Medicine, 
Mansoura University from April 1992 to August 2001. Blunt trauma in 13 (37.1%) patients , Penetrating in 15 (42.9%) patients and Gunshot in 7 (20%) patients. Head of the pancreas was injured in 9 (25.7%) patients , Body in 11 (31.4%) patients and tail in 15 (42.9%) patients. 
Complete blood count, abdominal ultrasound abdominal CT were done. Serum amylase was not done. Modified Lucas 
classification was utilized: class I in 12 (35.3) patients , class II in 7 (20%) patients , class III in 9 (25.9%) patients , class IVa 
in 5 (14.3%) patients and Class IVb in 2(5.7%) patients. Pancreaticduodecnetomy was done in 9 (25.7%) patients , closed 
external drainage in 15 (42.9%) patients and distal pancratectomy and splenectomy was done in 11 (31.4 %) patients . 
Associated injuries were colon in 10 (28%) Splenic in 7 (20%) patients, hepatic in 5 (14 %) patients, doudenum in 9 
(25.7%) patients , Gall bladder in two patients, superior mesenteric vessels in two patients , small intestine in three patients. 
GCS was of 10.3 and ISS was of 27.7. Complications included: pancreatic fistula in 6 (17%) patients, biliary leakage in one 
patient, intra- abdominal abscess in 6 (17%) patients , pancreatitis in 7 (20%) patients . pseudopancreatic cyst in 3 patients.
No longer diabetes was seen. Mortality occurred in nine patients (28.7%) : Five died from multiple organ failure and one from duodenal leakage following second exploration for secondary hemorrhage after severe trauma ,three died at operation from massive hemorrhage. Pancreatic trauma can be managed by pancreatic resection, or closed external drainage with good results. Morbidity and mortality were related to associated renal failure, proximal duct injury, pancreatico-duodenectomy, Haematemesis and melena , spine injury and pancreatic fistula.