Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, 1094 Tobera, Toyooka, Hyogo, 668-8501, Japan.
Inoue Clinic, 2-18-2 Togire, Nishi-ku, Fukuoka, 819-0032, Japan.
J Med Case Rep. 2021 Aug 13;15(1):404. doi: 10.1186/s13256-021-02995-z.
A high-grade pancreatic injury is a life-threatening injury that is associated with high mortality and morbidity. It is currently unclear which treatment strategy results in good clinical outcomes.
A 23-year-old Japanese woman sustained severe injury in a motor vehicle accident. Abdominal computed tomography revealed severe pancreatic head injury with extravasation of contrast media. Since it was not possible to insert an endoscopic pancreatic stenting tube into the main pancreatic duct, damage control surgery was performed. On day 3, we could insert the endoscopic pancreatic stenting tube from the ampulla of Vater and an endoscopic nasopancreatic drainage tube in the distal pancreatic duct from the accessory ampulla before the second operation. Drainage tubes were placed around the pancreatic head in the second operation. The endoscopic nasopancreatic drainage tube tube was converted to endoscopic pancreatic stenting tube on day 9. On day 51, the patient was discharged on foot from our hospital without serious complications.
Early and effective hemostasis, staged pancreatic duct drainage with stenting, and surgical external drainage around the pancreas in combination with an endoscopic procedure and damage control surgery were considered appropriate therapeutic strategy for high-grade pancreatic injury.
胰头严重损伤属于高等级胰腺损伤，具有较高的致死率和病残率，目前尚不清楚哪种治疗策略能获得良好的临床效果。
一名 23 岁的日本女性在一场机动车事故中遭受严重创伤。腹部计算机断层扫描显示严重的胰头损伤，造影剂外渗。由于无法将内镜胰管支架管插入主胰管，故实施了损伤控制性手术。第 3 天，我们可以从 Vater 壶腹插入内镜胰管支架管，从副乳头插入远端胰管的内镜鼻胰管引流管，然后在第二次手术前进行操作。第二次手术时在胰头部周围放置引流管。第 9 天，将内镜鼻胰管引流管转换为内镜胰管支架管。第 51 天，患者无严重并发症，从我院步行出院。
对于胰头严重损伤，早期有效止血、分期胰管支架引流、结合内镜和损伤控制性手术的胰腺周围外科外引流，被认为是一种合适的治疗策略。
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