Ayyasamy Lokeshwaran, Govindaraj Raman Senthilkumaran, Rengasamy Sudhagar, Alagendran Arun Raja, Nath Vivek G, Micheal Mathews, Chidambaram M Pon, Aravindan U
Department of Surgical Gastroenterology & GI Oncology, Thanjavur Medical College, Thanjavur, IND.
Cureus. 2025 May 13;17(5):e84027. doi: 10.7759/cureus.84027. eCollection 2025 May.
Pancreaticoduodenal injuries are complex, and early diagnosis is often missed due to their retroperitoneal location. Serial clinical monitoring and imaging are essential for the management of these injuries. Morbidity and mortality increase in patients with delayed presentation. The aim of this study is to analyse the demography, mode of presentation, grading, management, morbidity and mortality of these injuries at our centre.
This is an ambispective study conducted on 31 patients over a period of five years, between October 1, 2019 and October 15, 2024.
Most patients were male (93.5%). Blunt trauma was associated with the majority of cases (83.8%). Twenty-nine patients were hemodynamically stable on arrival at the trauma/emergency ward. Postoperative morbidity was around 32% in our study, whereas mortality was approximately 7%. Nonoperative management was followed in five cases of high-grade (Grade 4) pancreatic injury. One patient with Grade 5 pancreaticoduodenal injury underwent an emergency Whipple procedure. In our study, postoperative morbidity associated with delayed admission beyond 48 hours from the time of injury was statistically significant (p = 0.029).
A high index of suspicion is needed in every case. Delayed diagnosis and treatment negatively impact morbidity and mortality. In selected cases of high-grade pancreatic injuries, conservative management with serial follow-up and imaging can be considered at a well-equipped tertiary care centre.
胰十二指肠损伤情况复杂，因其位于腹膜后位置，早期诊断常被漏诊。连续的临床监测和影像学检查对这些损伤的处理至关重要。延迟就诊患者的发病率和死亡率会增加。本研究的目的是分析我院中心此类损伤的人口统计学特征、就诊方式、分级、处理方法、发病率和死亡率。
这是一项在2019年10月1日至2024年10月15日的五年期间对31例患者进行的双向研究。
大多数患者为男性（93.5%）。大多数病例（83.8%）与钝性创伤有关。29例患者抵达创伤/急诊病房时血流动力学稳定。在我们的研究中，术后发病率约为32%，而死亡率约为7%。5例高级别（4级）胰腺损伤采用非手术治疗。1例5级胰十二指肠损伤患者接受了急诊惠普尔手术。在我们的研究中，受伤后超过48小时延迟入院相关的术后发病率具有统计学意义（p = 0.029）。
每例病例都需要高度怀疑。延迟诊断和治疗会对发病率和死亡率产生负面影响。在选定的高级别胰腺损伤病例中，在设备完善的三级医疗中心可考虑采用连续随访和影像学检查的保守治疗方法。
