A comparison of blunt and penetrating pancreatic trauma

Abstract

Background: This project reviews our experience with managing pancreatic trauma from 2012 to 2018.

Methods: All patients over the age of 15 years with a pancreatic injury during the period December 2012–December 2018 were retrieved from the Hybrid  Electronic Medical Registry at Grey’s Hospital and reviewed.

Results: During the study period 161 patients sustained a pancreatic injury. The mechanism of trauma was penetrating in 86 patients (53%) and blunt in  75 (47%). The blunt mechanisms included MVA in 27, PVA in 15, falls in four and assaults in the remaining 29. There were 52 stab wounds and 34 gunshot  wounds of the pancreas. A total of 26 patients (16%) were shocked on presentation with a systolic blood pressure of 90 mm Hg or less. The median injury  severity score was 16. There were 90 patients with American Association for the Surgery of Trauma (AAST) grade I injury to the pancreas, 36 AAST grade  II, 27 AAST grade III, 7 AAST grade IV and a single AAST grade V. Fifty-four patients (34%) were initially treated non-operatively of which three eventually  required surgery. Of the patients who required surgery, 26 (16%) underwent a distal pancreatectomy. The remainder simply underwent pancreatic  drainage. The overall mortality rate was 13% (21/161). The operative mortality was 11% (18/161). Thirteen patients (8%) with penetrating injuries and  eight patients (5%) with blunt injuries died. Of the 21 patients who died, 14 had multiple injuries. Five patients died due to overwhelming sepsis. One  patient died due to hypovolemic shock and another due to a traumatic brain injury.

Conclusion: Our centre not infrequently deals with pancreatic trauma  secondary to both blunt and penetrating trauma. We follow the general principles outlined in the literature. Despite this, pancreatic trauma is  still associated with significant morbidity and mortality.