Clinical Review of Pancreaticoduodenal Injury

Choi, Seung Hye; Ahn, Chang Joon; Lim, Keun Woo; Kang, Rae Sung

J Korean Soc Emerg Med > Volume 1(1); 1990 > Article

Journal of The Korean Society of Emergency Medicine 1990;1(1): 138-149.

Seung Hye Choi, Chang Joon Ahn, Keun Woo Lim, Rae Sung Kang

ABSTRACT

In spite of advances in management of the victim of trauma, the reported incidence of mortality and significant morbidity after pancreatic and Zor duodenal injuries is still remained high. The key to treatment is thought to be early and accurate evaluation and proper management according to the degree of injury. We have respectively reviewed 45 patients who sustained pancreatic and/or duodenal injuries, surgically treated from January 1979 through December 1988, retrospectively, at the Department of Surgery, Daejeon St. Marys hospital and St. Paul hospital, Catholic University Medical College. There were 45 cases(10.3%) of pancreatic and /or duodenal injuries among 436 patients with abdominal traumas who were surgically treated. There were 41 men and 4 women, in the ratio 10.3: 1. Age incidence was the highest in the third and fourth decades(64. 5% ). Most of them(95. 6 %) were injured by blunt trauma, 25 out of 45 cases by traffic accident, sixteen by altercation and violation. Two cases were injured by penetrating trauma. The most significant .clinical manifestation was abdominal pain with peritoneal irritation signs. 26 cases(57.8%) were diagnosed during the exploratory laparotomy. According to the classification by Lucas(1977), pancreatic injuries of class I were 6 cases, duodenal injury one. Pancreatic injuries of dass II were 11 cases, duodenal injuries 16. Pancreatic injuries of class III were 4 cases, and combined pancreaticoduodenal injuries(class 1V) were 5 cases. 8 patients with pancreatic injury were treated by hemostasis and drainage, 6 by distal pancreatectomy, and 2 by Roux en Y cystojejunostomy because of pseudocyst formation. 8 patients with duodenal injuries were treated by duodenal diverticulization, 7 by primary repair, and 3 by Roux en Y or side to side duodenojunostomy. 3 patients were performed Whipples pancreaticoduodenectomy due to severe combined pancreaticoduodenal injury. 6 out of 21 pancreatic injuries(28.6%) were troubled with early postoperative complications, 7 out of 19 duodenal injuries(36. 8%) and all of combined injuries, as bleeding, infection, pulmonary complication, and so on. 14 out of 45 cases(31.1%) were late complicated with pancreatic pseudocyst, pancreatic or enterocutaneous fistula, adhesive ileus. 7 patients were died of septic lung, sepsis, cardiopulmonary or acute renal failure, in the mortality rate 15.5%.