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Pancreatic Injury

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An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study.
Phelan HA, Velmahos GC, Jurkovich GJ, Friese RS, Minei JP, Menaker JA, Philp A, Evans HL, Gunn ML, Eastman AL, Rowell SE, Allison CE, Barbosa RL, Norwood SH, Tabbara M, Dente CJ, Carrick MM, Wall MJ, Feeney J, O'Neill PJ, Srinivas G, Brown CV, Reifsnyder AC, Hassan MO, Albert S, Pascual JL, Strong M, Moore FO, Spain DA, Purtill MA, Edwards B, Strauss J, Durham RM, Duchesne JC, Greiffenstein P, Cothren CC.
J Trauma. 2009 Mar;66(3):641-6; discussion 646-7.

Rationale for inclusion: This AAST multi-center trial evaluated the sensitivity and specificity of 16 and 64 multidetector CT to identify pancreatic and pancreatic ductal injury.  While highly specific for ductal injury, they have low sensitivity for detection of pancreatic injury.

Citations - 83 (as of July 2017)

Management of blunt major pancreatic injury.
Lin BC, Chen RJ, Fang JF, Hsu YP, Kao YC, Kao JL.
J Trauma. 2004 Apr;56(4):774-8.

Rationale for inclusion: Using 48 patients, this paper describes a series of blunt pancreatic injuries, supporting the use of distal pancreatectomy with splenic preservation with lower complication rates.

Citations - 240 (as of July 2017)

Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries.
Asensio JA, Petrone P, Roldán G, Kuncir E, Demetriades D.
J Am Coll Surg. 2003 Dec;197(6):937-42.

Rationale for inclusion: This review evaluated a 10 year experience of complex pancreatoduodenal  injuries requiring Whipple procedure and concluded while uncommon, these are all AAST grade V pancreatic and duodenal injuries with overall survival of only 67%.

Citations - 134 (as of July 2017)

Predictors of morbidity after traumatic pancreatic injury.
Kao LS, Bulger EM, Parks DL, Byrd GF, Jurkovich GJ.
J Trauma. 2003 Nov;55(5):898-905.

Rationale for inclusion: This study validated the AAST organ injury grading system for pancreatic injury.

Citations - 140 (as of July 2017)

Pancreatic stent placement for duct disruption.
Telford JJ, Farrell JJ, Saltzman JR, Shields SJ, Banks PA, Lichtenstein DR, Johannes RS, Kelsey PB, Carr-Locke DL.
Gastrointest Endosc. 2002 Jul;56(1):18-24.

Rationale for inclusion: Although a minority of patients included in this study had sustained trauma, this series supported the placement of bridging pancreatic stents used to cross pancreatic ductal disruptions, citing improved resolution of leaks with stenting in this diverse population.

CAVEAT: Majority of patients studied had evidence of pancreatic ductal disruption due to pancreatitis.

Citations - 212 (as of July 2017)

Magnetic resonance cholangiopancreatography (MRCP) in the assessment of pancreatic duct trauma and its sequelae: preliminary findings.
Fulcher AS, Turner MA, Yelon JA, McClain LC, Broderick T, Ivatury RR, Sugerman HJ.
J Trauma. 2000 Jun;48(6):1001-7.

Rationale for inclusion: In a small series (10 stable trauma patients), MRCP was feasible and reliably identified pancreatic ductal trauma in a noninvasive method.

Citations - 151 (as of July 2017)

Diagnosis and initial management of blunt pancreatic trauma: guidelines from a multiinstitutional review.
Bradley EL 3rd, Young PR Jr, Chang MC, Allen JE, Baker CC, Meredith W, Reed L, Thomason M.
Ann Surg. 1998 Jun;227(6):861-9.

Rationale for inclusion: This study identified that the main cause of morbidity after pancreatic trauma is attributable to injury to the main pancreatic duct while recognizing that current CT modalities are unreliable in diagnosing ductal injury.

Citations - 351 (as of July 2017)

Pancreatic trauma: a simplified management guideline.
Patton JH Jr, Lyden SP, Croce MA, Pritchard FE, Minard G, Kudsk KA, Fabian TC.
J Trauma. 1997 Aug;43(2):234-9; discussion 239-41.

Rationale for inclusion: Supporting the trend toward simplified management for pancreatic injuries, this paper established an approach utilizing successful drainage of proximal injuries and most distal injuries, with distal pancreatectomy performed only if high probability for ductal injury.

Citations - 179 (as of July 2017)

Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations.
Takishima T, Sugimoto K, Hirata M, Asari Y, Ohwada T, Kakita A.
Ann Surg. 1997 Jul;226(1):70-6.

Rationale for inclusion: To improve detection of pancreatic injury, this study determined that serum amylase levels drawn within 3 hours of injury are not diagnostic and should be measured >3 hours following trauma.  

Citations - 158 (as of July 2017)

Management of combined pancreatoduodenal injuries.
Feliciano DV, Martin TD, Cruse PA, Graham JM, Burch JM, Mattox KL, Bitondo CG, Jordan GL Jr.
Ann Surg. 1987 Jun;205(6):673-80.

Rationale for inclusion: This case series evaluated 129 patients with combined pancreatoduodenal injuries, recommending the use of pyloric  exclusion and gastrojejunostomy to combat the high morbidity and fistula rate in this study.  

Citations - 180 (as of July 2017)

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