Duggan W, Hannan E, Brosnan C, O'Sullivan S, Conlon K
St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland.
St Vincent's University Hospital, 196 Merrion Road, Elm Park, Dublin, Ireland.
Int J Surg Case Rep. 2020;71:222-224. doi: 10.1016/j.ijscr.2020.05.011. Epub 2020 May 21.
Isolated pancreatic body transection secondary to blunt abdominal trauma is a very rare injury associated with poor outcomes. Almost all previously reported cases were managed by emergency distal pancreatectomy, which is associated with high morbidity and mortality. To our knowledge, this is the first reported case of complete transection of the pancreas at the body that was successfully treated by conservative management in an adult patient.
A 19-year-old male was found to have complete transection of the pancreatic body on computed tomography (CT) following blunt force abdominal trauma. Given that he was haemodynamically stable without evidence of haemorrhage or bile leakage on imaging, a trial of conservative management was initiated. He remained well through his admission, gradually improving clinically and biochemically with stable appearances on serial imaging. He remains asymptomatic as of six months since discharge from the hospital and continues to be monitored in the outpatient setting.
Management of pancreatic trauma with ductal injury has typically been with emergency distal pancreatectomy, which is associated with high morbidity and mortality. The decision to operate should not be purely based on radiological findings, and should take into account clinical status, haemodynamic stability, coexisting injuries and evidence of active haemorrhage or bile leak.
In select cases, it is reasonable to trial conservative management in isolated traumatic pancreatic body fracture by means of close clinical observation and serial imaging. This may allow the patient to avoid a high-risk emergency distal pancreatectomy.
钝性腹部创伤继发的孤立性胰体横断伤是一种非常罕见的损伤，预后较差。几乎所有先前报道的病例均采用急诊远端胰腺切除术治疗，该手术具有较高的发病率和死亡率。据我们所知，这是首例报道的成年患者胰体完全横断伤通过保守治疗成功治愈的病例。
一名19岁男性在钝性腹部创伤后，经计算机断层扫描（CT）发现胰体完全横断。鉴于其血流动力学稳定，影像学检查未发现出血或胆汁渗漏迹象，遂开始试行保守治疗。他在住院期间情况良好，临床和生化指标逐渐改善，系列影像学检查显示病情稳定。自出院六个月以来，他一直无症状，目前仍在门诊接受监测。
伴有导管损伤的胰腺创伤通常采用急诊远端胰腺切除术治疗，该手术具有较高的发病率和死亡率。手术决策不应单纯基于影像学检查结果，而应综合考虑临床状况、血流动力学稳定性、合并伤以及活动性出血或胆汁渗漏的证据。
在某些情况下，对于孤立性创伤性胰体骨折试行保守治疗，通过密切临床观察和系列影像学检查是合理的。这可能使患者避免进行高风险的急诊远端胰腺切除术。
