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South African Journal of Surgery

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Pancreaticoduodenal injuries: Re-evaluating current management approaches

GE Chinnery, TE Madiba

Abstract


Background. Pancreaticoduodenal injuries are uncommon
owing to the protected position of the pancreas and duodenum
in the retroperitoneum. Management depends on the extent of injury. This study was undertaken to document outcome of pancreaticoduodenal injuries and to re-evaluate our
approach.
Patients and methods. A prospective study of all patients
treated for pancreaticoduodenal trauma in one surgical ward
at King Edward VIII hospital over a 7-year period (1998 -2004). Demographic data, clinical presentation, findings at laparotomy and outcome were documented. Prophylactic antibiotics were given at induction of anaesthesia.
Results. A total of 488 patients underwent laparotomy over
this period, 43 (9%) of whom (all males) had pancreatic and
duodenal injuries. Injury mechanisms were gunshot (30), stabbing
(10) and blunt trauma (3). Their mean age was 30.1+9.6 years. Delay before laparotomy was 12.8+29.1 hours. Seven were admitted in shock. Mean Injury Severity Score (ISS) was 14+8.6. Management of 20 duodenal injuries was primary repair (14), repair and pyloric exclusion (3) and conservative (3). Management of 15 pancreatic injuries was drainage alone (13), conservative management of pseudocyst (1) and distal pancreatectomy (1). Management of 8 combined pancreaticoduodenal injuries was primary duodenal repair and pancreatic drainage (5) and repair with pyloric exclusion of duodenal
injury and pancreatic drainage (3). Twenty-one patients (49%)
developed complications, and 28 required ICU admission
with a median ICU stay of 4 days. Ten patients died (23%).
Mean hospital stay was 18.3+24.4 days.
Conclusions. The overall mortality was comparable with
that in the world literature. We still recommend adequate exploration
of the pancreas and duodenum and conservative operative management where possible.



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