Trauma Pancreático Penetrante Severo-Revisión Retrospectiva de Una Serie de Casos Manejados Con Una Estrategia Simplificada en un Centro de Trauma Nivel 1.

INTRODUCTION

Pancreatic trauma has a low incidence in both closed and penetrating injuries. The risk for morbidity and mortality is associated with injury severity of multiple organ injuries.

OBJECTIVE

To describe the characteristics of patients with penetrating pancreatic trauma treated at Foundation Valle del Lili (FVL), analyze the treatment performed and possible variables associated with the occurrence of complications related to injury to the pancreas and its treatment.

MATERIALS AND

METHODS

A retrospective review was made. The medical records of patients with abdominal trauma penetrating with pancreatic injury seen in FVL between 2000 and 2013, and who survived more than 48 hours. We analyzed demographic variables, severity of trauma and management related to the development of pancreatic fistula.

RESULTS

Twenty-eight patients were identified with median age 30 years (21-38). Eight (28%) were admitted in shock (SBP <90 mm Hg). The anatomical severity measured by the PATI had median 50 (34.5-67.5). The number of organs injured: a median of 5 (5-6). Twenty-one patients (75%) had major vascular injuries, 19 (68%) gastric injury, 14 (50%) colon, 12 (43%) liver, small intestine 12 and 11 (39%) duodenal. The severity of pancreatic injury was a median of 3 (2-4). Treatment of pancreatic lesion consisted of suture in 12 cases (42.8%), distal resection in 8 (28.6%) and packing in 8. Local complications occurred in 23 patients (83%), abdominal sepsis in 19 (68%), pancreatic fistula in eight (29%) and intestinal fistula in six (21%). Four patients (14%) died, two from sepsis and two from multiorgan failure. No association was found between severity of trauma or damaged organs and the risk of fistula. Only pancreatic suture was associated with lower risk of complication.

COMMENT: We present a series of patients with penetrating pancreatic trauma with a high prevalence of serious injuries and associated morbidity, despite which mortality was reduced. Simple suture of the pancreatic injury was associated with lower risk of fistula.