Shimizu Dai, Yamano Toshihisa, Kudo Yasutaka, Kuroda Masatoshi, Takagi Shoji, Ikeda Eiji, Kenmotsu Masaichi, Tsuji Hisashi
Department of Digestive Surgery, Japanese Red Cross Okayama Hospital, 2-1-1 Aoe Kitaku, Okayama 700-8607, Japan.
Trauma Case Rep. 2020 May 30;28:100319. doi: 10.1016/j.tcr.2020.100319. eCollection 2020 Aug.
Pancreatic trauma involving ductal injury is rare but is associated with high morbidity and mortality. The benefit of endoscopic retrograde pancreatography and stent placement is unclear because there are only a few case reports on endoscopically treated pancreatic duct transection at the pancreatic head. We report a rare case of grade IV pancreatic trauma successfully treated with endoscopic pancreatic stent, which we believe makes significant contribution to the existing literature. A 17-year-old man with blunt pancreatic trauma was referred to our hospital and was diagnosed with grade IV pancreatic injury using endoscopic retrograde pancreatography. The patient was successfully managed with endoscopic pancreatic duct stenting. Although stent replacement was required three times and a trivial ductal stricture remained, the patient finally became stent-free without any symptoms and further adverse events. Endoscopic retrograde pancreatography is highly advantageous for early detection and evaluation of the severity of ductal injury. Subsequent stent insertion is well tolerated in hemodynamically stable patients and is especially beneficial for the treatment of pancreatic head injuries because it allows avoidance of sub-total pancreatectomy or high-risk reconstructive surgery. Nevertheless, the long-term outcomes and appropriate management of main pancreatic duct strictures due to stents remain to be determined. Accumulation of similar case experiences is essential to address these issues.
涉及导管损伤的胰腺创伤罕见，但发病率和死亡率很高。内镜逆行胰胆管造影术（ERCP）及支架置入的益处尚不清楚，因为关于内镜治疗胰头处胰腺导管横断的病例报告很少。我们报告了1例罕见的IV级胰腺创伤，成功通过内镜下胰腺支架治疗，我们认为这对现有文献有重要贡献。一名17岁钝性胰腺创伤男性被转诊至我院，通过内镜逆行胰胆管造影术诊断为IV级胰腺损伤。该患者通过内镜下胰管支架置入成功治疗。尽管需要三次更换支架且仍有轻微导管狭窄，但患者最终无需支架且无症状及进一步不良事件。内镜逆行胰胆管造影术对于早期检测和评估导管损伤的严重程度非常有利。在血流动力学稳定的患者中，随后的支架置入耐受性良好，对于胰头损伤的治疗尤其有益，因为它可避免胰次全切除术或高风险的重建手术。然而，由于支架导致的主胰管狭窄的长期结局及适当管理仍有待确定。积累类似病例经验对于解决这些问题至关重要。
