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Injuries to the duodenum and pancreas

1999; Springer Science+Business Media; Volume: 31; Issue: 2 Linguagem: Inglês

10.1007/bf02619795

1563-2563

Hans Rabl,

Abdominal Trauma and Injuries

Background: Blunt or penetrating-perforating severe abdominal trauma involves the duodenum in of 3.7 to 5% of cases and the pancreas in 3 to 12%. In our geographical area, the great majority of injuries to the duodenum and pancreas result from traffic accidents. More than 90% of accident victims have severe concomitant injuries to the liver, spleen and large vessels. The clinical symptoms of pancreatic-duodenal injuries are often inversely proportional to the severity of those injuries and are usually obscured by the other injuries. Methods: When the patient is in shock, operative exploration is the diagnostic method of choice. When cardiocirculatory parameters are stable, (contrast) CT has proven to have a sensitivity and specificity of over 80%. ERCP is useful for preoperative imaging of the pancreatic duct with late manifestations or when an injury has been overlooked. The significance of hyperamylasemia is often overestimated as 40% of all pancreas injuries show normal serum levels. Results: The classification published by the American Association for Surgery of Trauma has proved to be useful for classifying and evaluating injury patterns and severity of injury for both organs. Conclusions: When the descending part of the duodenum (D2) or pancreatic duct is involved, treatment will be problematic and the outcome questionable. The complication rate for duodenal injuries after adequate treatment is 1.3–18.4%, and for pancreatic injuries, 20–35%. The respective mortality rates are 6.5 to 12% and 10 to 20%.