Pancreatic Trauma

Bindi Naik-Mathuria, M.D., M.P.H., Nikhil R Shah, M.D., Steven Stylianos, MD, Barry R. Cofer, MD, Kathryn D. Bass, MD
Pancreatic Trauma is a topic covered in the Pediatric Surgery NaT.

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Introduction

Traumatic pancreatic injury occurs most commonly in the setting of blunt trauma and can be a partial injury or complete transection. Unlike injury to other solid abdominal organs, bleeding is a rare sequela of pancreatic injuries. It is the leakage of pancreatic enzymes from a disrupted pancreatic duct that leads to the majority of complications. Nonoperative management (NOM) is now commonly accepted as the standard of care for other blunt solid abdominal organ injuries, yet the management of pancreatic injuries with duct transection still remains controversial. In adults, the standard of care for these injuries is operative management (OM), typically with distal pancreatectomy [1]. In children, however, non-operative management (NOM) has gained traction in the past few decades given increasing reports of success, as well as offering the advantages of avoiding a painful operation, inadvertent splenectomy, and sparing pancreatic parenchyma that may lead to future pancreatic insufficiency. Nonetheless, consensus regarding optimal management for these rare injuries (OM versus NOM) remains controversial in the pediatric population due to lack of high-quality evidence stemming from retrospective reviews with heterogeneity due to practice variability [2][3].

Content in this module is referenced in SCOREAbdominal Trauma overview

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Introduction

Traumatic pancreatic injury occurs most commonly in the setting of blunt trauma and can be a partial injury or complete transection. Unlike injury to other solid abdominal organs, bleeding is a rare sequela of pancreatic injuries. It is the leakage of pancreatic enzymes from a disrupted pancreatic duct that leads to the majority of complications. Nonoperative management (NOM) is now commonly accepted as the standard of care for other blunt solid abdominal organ injuries, yet the management of pancreatic injuries with duct transection still remains controversial. In adults, the standard of care for these injuries is operative management (OM), typically with distal pancreatectomy [1]. In children, however, non-operative management (NOM) has gained traction in the past few decades given increasing reports of success, as well as offering the advantages of avoiding a painful operation, inadvertent splenectomy, and sparing pancreatic parenchyma that may lead to future pancreatic insufficiency. Nonetheless, consensus regarding optimal management for these rare injuries (OM versus NOM) remains controversial in the pediatric population due to lack of high-quality evidence stemming from retrospective reviews with heterogeneity due to practice variability [2][3].

Content in this module is referenced in SCOREAbdominal Trauma overview

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Last updated: November 30, 2022