The Management and Long-term Outcome of Traumatic Pancreatic Type Ⅲb Injuries
[Background] Diagnosis and selection of the optimal surgical procedure for traumatic pancreatic type Ⅲb injuries are difficult, and evaluation of short-and long-term outcomes are important. [Objective] We evaluated the treatment strategy with endoscopic retrograde cholangiopancreatography (ERCP) and...
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| Published in | Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 39; no. 5; pp. 839 - 843 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japanese Society for Abdominal Emergency Medicine
31.07.2019
日本腹部救急医学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1340-2242 1882-4781 |
| DOI | 10.11231/jaem.39.839 |
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| Abstract | [Background] Diagnosis and selection of the optimal surgical procedure for traumatic pancreatic type Ⅲb injuries are difficult, and evaluation of short-and long-term outcomes are important. [Objective] We evaluated the treatment strategy with endoscopic retrograde cholangiopancreatography (ERCP) and the short-and long-term outcomes for traumatic pancreatic Ⅲb type injury cases. [Subjects and results] Nine patients underwent surgical treatment for traumatic pancreatic Ⅲb type injuries in our department from July 2007 to June 2018. The median age was 31 (8〜77) years. Two of the 9 cases (22％) were able to be diagnosed as having a main pancreatic duct injury from CT findings, Among 9 cases, the main pancreatic duct injury was diagnosed with CT in two cases, while it was diagnosed with ERCP in 7 cases, the injury was diagnosed in all cases. Four cases (44％) had a pancreatic fistula, and one case (11％) had bile leakage postoperatively. The median follow-up time was 57 months (5〜80 months). Four (50％) and 2 (25％) out of 8 cases performed pancreatoduodenectomy (PD) had stenosis of their choledochojejunostomy and pancreatojejunostomy anastomosis respectively and 2 (25％) underwent a reoperation for the treatment. [Conclusion] ERCP for traumatic pancreatic Ⅲb type injuries was more useful to evaluate the damage of the main pancreatic duct than CT. There were late complications in young cases, and this fact is a future issue. |
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| AbstractList | [Background] Diagnosis and selection of the optimal surgical procedure for traumatic pancreatic type Ⅲb injuries are difficult, and evaluation of short-and long-term outcomes are important. [Objective] We evaluated the treatment strategy with endoscopic retrograde cholangiopancreatography (ERCP) and the short-and long-term outcomes for traumatic pancreatic Ⅲb type injury cases. [Subjects and results] Nine patients underwent surgical treatment for traumatic pancreatic Ⅲb type injuries in our department from July 2007 to June 2018. The median age was 31 (8〜77) years. Two of the 9 cases (22％) were able to be diagnosed as having a main pancreatic duct injury from CT findings, Among 9 cases, the main pancreatic duct injury was diagnosed with CT in two cases, while it was diagnosed with ERCP in 7 cases, the injury was diagnosed in all cases. Four cases (44％) had a pancreatic fistula, and one case (11％) had bile leakage postoperatively. The median follow-up time was 57 months (5〜80 months). Four (50％) and 2 (25％) out of 8 cases performed pancreatoduodenectomy (PD) had stenosis of their choledochojejunostomy and pancreatojejunostomy anastomosis respectively and 2 (25％) underwent a reoperation for the treatment. [Conclusion] ERCP for traumatic pancreatic Ⅲb type injuries was more useful to evaluate the damage of the main pancreatic duct than CT. There were late complications in young cases, and this fact is a future issue.
【背景】外傷性膵Ⅲb型損傷の診断と至適術式選択は難しく，短期/長期成績評価が重要である。【目的】外傷性膵Ⅲb型損傷症例に対するERCPによる術前診断と短期/長期成績を評価する。【対象と結果】2007年7月から2018年6月に当科で外傷性膵Ⅲb型損傷に対し外科治療を行った9例。年齢中央値は31歳（8〜77歳）。CTで主膵管損傷を診断し得たのは9例中2例（22％）だが，ERCPでは7例全例で主膵管損傷（完全断裂4例，部分損傷3例）が診断された。膵瘻4例（44％），胆汁瘻1例（11％）。観察期間中央値57ヵ月（5〜80ヵ月）で，PDを施行した8例のうち若年齢を中心に吻合部狭窄（胆管空腸4例（50％），膵空腸2例（25％））を認め，2例（25％）で再手術を要した。【結語】外傷性膵Ⅲb型損傷に対するERCPはより正確な主膵管損傷評価が可能。若年例に晩期合併症を認め，今後の課題である。 [Background] Diagnosis and selection of the optimal surgical procedure for traumatic pancreatic type Ⅲb injuries are difficult, and evaluation of short-and long-term outcomes are important. [Objective] We evaluated the treatment strategy with endoscopic retrograde cholangiopancreatography (ERCP) and the short-and long-term outcomes for traumatic pancreatic Ⅲb type injury cases. [Subjects and results] Nine patients underwent surgical treatment for traumatic pancreatic Ⅲb type injuries in our department from July 2007 to June 2018. The median age was 31 (8〜77) years. Two of the 9 cases (22％) were able to be diagnosed as having a main pancreatic duct injury from CT findings, Among 9 cases, the main pancreatic duct injury was diagnosed with CT in two cases, while it was diagnosed with ERCP in 7 cases, the injury was diagnosed in all cases. Four cases (44％) had a pancreatic fistula, and one case (11％) had bile leakage postoperatively. The median follow-up time was 57 months (5〜80 months). Four (50％) and 2 (25％) out of 8 cases performed pancreatoduodenectomy (PD) had stenosis of their choledochojejunostomy and pancreatojejunostomy anastomosis respectively and 2 (25％) underwent a reoperation for the treatment. [Conclusion] ERCP for traumatic pancreatic Ⅲb type injuries was more useful to evaluate the damage of the main pancreatic duct than CT. There were late complications in young cases, and this fact is a future issue. |
| Author | Matsukawa, Hiroyuki Uemura, Jun Noge, Seiji Suto, Hironobu Oshima, Minoru Ando, Yasuhisa Suzuki, Yasuyuki Okano, Keiichi Asano, Eisuke |
| Author_FL | 野毛 誠示 安藤 恭久 鈴木 康之 岡野 圭一 大島 稔 上村 淳 浅野 栄介 松川 浩之 須藤 広誠 |
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| Author_xml | – sequence: 1 fullname: Ando, Yasuhisa organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Okano, Keiichi organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Asano, Eisuke organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Uemura, Jun organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Oshima, Minoru organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Suzuki, Yasuyuki organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Suto, Hironobu organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Matsukawa, Hiroyuki organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University – sequence: 1 fullname: Noge, Seiji organization: Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University |
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| References | 6) 岡野圭一，安藤恭久，須藤広誠，ほか：膵損傷の手術．手術 2019；73：135-145 21) Degiannis E, Levy RD, Potokar T, et al: Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995; 82: 1240–1242. 24) Sinwar PD: Overwhelming post splenectomy infection syndrome-review study. Int J Surg 2014; 12: 1314-1316. 8) Bassi C, Marchegiani G, Dervenis C, et al: The 2016 update of the International Study Group （ISGPS） definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017; 161: 584-591. 26) Kim S, Kim JW, Jung PY, et al: Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years. Int J Surg 2017; 42: 152-157. 10) 加来信雄：外傷性腹部実質臓器損傷 診断と治療 膵損傷；診断と治療の進歩．消外1995；18：1815-1824 1) 若狭悠介，木村憲央，袴田健一：膵外傷の治療体系．胆と膵2018；39：45-48 16) Hasegawa K, Kokudo N, Sano K, et al: Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results. Am J Surg 2008; 196: 3-10. 23) 大久保和明：膵外傷―その診断と対策―．肝胆膵 1996；33：843-850. 25) Phelan HA, Velmahos GC, Jurkovich GJ, et al: An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma 2009; 66: 641-646, discussion 646-647. 4) Bracey DW: Complete rupture of the pancreas. Br J Surg 1961; 48: 575-576. 13) Lowe RJ, Saletta JD, Moss GS: Pancreatoduodenectomy for penetrating pancreatic trauma. J Trauma 1977; 17: 732-741. 2) Warshaw AL: Conservation of the spleen with distal pancreatectomy. Arch Surg 1988; 123: 550-553. 20) Krige JE, Kotze UK, Nicol AJ, et al: Morbidity and mortality after distal pancreatectomy for trauma: a critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre. Injury 2014; 45: 1401–1408. 17) Peck GL, Blitzer DN, Bulauitan CS, et al: Outcomes after distal pancreatectomy for trauma in the modern era. Am Surg 2016; 82: 526–532. 9) 日本外傷学会臓器損傷分類委員会：膵損傷分類2008（日本外傷学会）．日外傷会誌2008；22 ：264. 22) Lewis G, Knottenbelt JD, Krige JE: Conservative surgery for trauma to the pancreatic head: is it safe？ Injury 1991; 22: 372–374. 3) Letton AH, Wilson JP: Traumatic severance of pancreas treated by Roux-Y anastomosis. Surg Gynecol Obstet 1959; 109: 473-478. 5) Martin LW, Henderson BM, Welsh N: Disruption of the head of the pancreas caused by blunt trauma in children: a report of two cases treated with primary repair of the pancreatic duct. Surgery 1968; 63: 697-700. 11) Tyburski JG, Wilson RF, Dente C, et al: Factors Affecting Mortality Rates in Patients with Abdominal Vascular Injuries. J Trauma 2001; 50: 1020-1026. 12) Ho VP, Patel NJ, Bokhari F, et al: Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 82: 185-199. 14) Nance FC, DeLoach DH: Pancreaticoduodenectomy following abdominal trauma. J Trauma 1971; 11: 577-585. 15) Brenner M, Bochicchio G, Bochicchio K, et al: Long-term impact of damage control laparotomy: A prospective study. Arch Surg 2011; 146: 395-399. 18) Fahy BN, Frey CF, Ho HS, et al: Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002; 183: 237-241. 19) Cogbill TH, Moore EE, Morris JA Jr, et al: Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31: 1600–1606. 7) 須田竜一郎，枝元良広，徳原 真，ほか：成人Ⅲb型膵体尾部鈍的損傷に対する膵温存治療の試み．日消外会誌 2018；51：86-94 |
| References_xml | – reference: 15) Brenner M, Bochicchio G, Bochicchio K, et al: Long-term impact of damage control laparotomy: A prospective study. Arch Surg 2011; 146: 395-399. – reference: 13) Lowe RJ, Saletta JD, Moss GS: Pancreatoduodenectomy for penetrating pancreatic trauma. J Trauma 1977; 17: 732-741. – reference: 17) Peck GL, Blitzer DN, Bulauitan CS, et al: Outcomes after distal pancreatectomy for trauma in the modern era. Am Surg 2016; 82: 526–532. – reference: 1) 若狭悠介，木村憲央，袴田健一：膵外傷の治療体系．胆と膵2018；39：45-48． – reference: 3) Letton AH, Wilson JP: Traumatic severance of pancreas treated by Roux-Y anastomosis. Surg Gynecol Obstet 1959; 109: 473-478. – reference: 18) Fahy BN, Frey CF, Ho HS, et al: Morbidity, mortality, and technical factors of distal pancreatectomy. Am J Surg 2002; 183: 237-241. – reference: 20) Krige JE, Kotze UK, Nicol AJ, et al: Morbidity and mortality after distal pancreatectomy for trauma: a critical appraisal of 107 consecutive patients undergoing resection at a Level 1 Trauma Centre. Injury 2014; 45: 1401–1408. – reference: 6) 岡野圭一，安藤恭久，須藤広誠，ほか：膵損傷の手術．手術 2019；73：135-145． – reference: 4) Bracey DW: Complete rupture of the pancreas. Br J Surg 1961; 48: 575-576. – reference: 10) 加来信雄：外傷性腹部実質臓器損傷 診断と治療 膵損傷；診断と治療の進歩．消外1995；18：1815-1824． – reference: 19) Cogbill TH, Moore EE, Morris JA Jr, et al: Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31: 1600–1606. – reference: 14) Nance FC, DeLoach DH: Pancreaticoduodenectomy following abdominal trauma. J Trauma 1971; 11: 577-585. – reference: 8) Bassi C, Marchegiani G, Dervenis C, et al: The 2016 update of the International Study Group （ISGPS） definition and grading of postoperative pancreatic fistula: 11 Years After. Surgery 2017; 161: 584-591. – reference: 25) Phelan HA, Velmahos GC, Jurkovich GJ, et al: An evaluation of multidetector computed tomography in detecting pancreatic injury: results of a multicenter AAST study. J Trauma 2009; 66: 641-646, discussion 646-647. – reference: 22) Lewis G, Knottenbelt JD, Krige JE: Conservative surgery for trauma to the pancreatic head: is it safe？ Injury 1991; 22: 372–374. – reference: 9) 日本外傷学会臓器損傷分類委員会：膵損傷分類2008（日本外傷学会）．日外傷会誌2008；22 ：264. – reference: 16) Hasegawa K, Kokudo N, Sano K, et al: Two-stage pancreatojejunostomy in pancreaticoduodenectomy: a retrospective analysis of short-term results. Am J Surg 2008; 196: 3-10. – reference: 7) 須田竜一郎，枝元良広，徳原 真，ほか：成人Ⅲb型膵体尾部鈍的損傷に対する膵温存治療の試み．日消外会誌 2018；51：86-94． – reference: 26) Kim S, Kim JW, Jung PY, et al: Diagnostic and therapeutic role of endoscopic retrograde pancreatography in the management of traumatic pancreatic duct injury patients: Single center experience for 34 years. Int J Surg 2017; 42: 152-157. – reference: 23) 大久保和明：膵外傷―その診断と対策―．肝胆膵 1996；33：843-850. – reference: 2) Warshaw AL: Conservation of the spleen with distal pancreatectomy. Arch Surg 1988; 123: 550-553. – reference: 5) Martin LW, Henderson BM, Welsh N: Disruption of the head of the pancreas caused by blunt trauma in children: a report of two cases treated with primary repair of the pancreatic duct. Surgery 1968; 63: 697-700. – reference: 11) Tyburski JG, Wilson RF, Dente C, et al: Factors Affecting Mortality Rates in Patients with Abdominal Vascular Injuries. J Trauma 2001; 50: 1020-1026. – reference: 24) Sinwar PD: Overwhelming post splenectomy infection syndrome-review study. Int J Surg 2014; 12: 1314-1316. – reference: 12) Ho VP, Patel NJ, Bokhari F, et al: Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017; 82: 185-199. – reference: 21) Degiannis E, Levy RD, Potokar T, et al: Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995; 82: 1240–1242. |
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