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Pancreaticoduodenal Trauma in the 21st Century: A Current View
*Elizaveta Ragulin-Coyne, *Heena Santry, *Jillian K Smith, *Elan R Witkowski, *Charles Psoinos, *Sing-Chau Ng, *Shimul A Shah, Jennifer F Tseng
University of Massachusetts Medical School, Worcester, MA
Pancreaticoduodenal (PD) trauma is rare but potentially lethal. We analyzed incidence, treatment, and outcomes of PD injuries at a level 1 trauma center.
Prospective institutional trauma registry 2000-2010 and retrospective record review.
Single academic institution.
All patients with pancreatic and/or duodenal trauma 2000-2010 identified using ICD9, excluding deaths within 24 hrs.
Main Outcome Measures:
Demographics, mechanism, time to PD diagnosis, associated injuries, treatment, complications, mortality, length of stay, length of ICU stay, and disposition. Multivariate analysis to identify predictors of in-hospital complications and mortality.
111 patients(23 children,88 adults) were identified. All pediatric injuries were blunt, 78.3% vehicular; of adult PD injuries, 9(10.2%) were penetrating and 79(90.8%) were blunt, 58 (73.4%) were vehicular. Of adults with vehicular injuries, 75.9% were unrestrained; 32.8% were alcohol-related. For children and adults, respectively, 52% vs. 62.5% underwent operation; 4.4% vs. 11.4% required percutaneous drainage, 8.7 vs. 8.0% required ERCP/stenting. 76.2% of adults and 65% of children required ICU, median hospital LOS averaged 13 days for all patients regardless of age or intervention. In-hospital mortality was 3.4% for adults and 0% for pediatric patients. Complication rate was 35.2% for adults and 39.1% for children.
Pancreaticoduodenal injuries, while infrequent, demonstrate a complex spectrum across injured children and adults at an academic teaching hospital. Although mortality is usually avoided, morbidity remains considerable. Vigilance and a high index of suspicion on the initial trauma evaluation may be critical to favorable outcomes.
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May 5, 2014
August 13, 2014
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August 11, 2014