Rogers SJ, Cello JP, Schechter WP. Endoscopic retrograde cholangiopancreatography in patients with pancreatic trauma

Department of Medicine, University of California, San Francisco, San Francisco, California, United States
The Journal of trauma (Impact Factor: 2.96). 12/2009; 68(3):538-44. DOI: 10.1097/TA.0b013e3181b5db7a
Source: PubMed


: Pancreatic injury occurs in from 3% to 12% of patients with abdominal trauma. In many instances, a lack of impressive findings in the first 24 hours leads to a delay in diagnosis. Because pancreatic duct disruption is the major cause of traumatic pancreatitis, we evaluated our experience with endoscopic retrograde cholangiopancreatography (ERCP) in patients suspected of having of having pancreatic injury.
: We reviewed the medical records of 26 patients evaluated perioperatively by ERCP for suspected pancreatic duct injury. The examinations were performed in the endoscopy suite or radiography special procedures or operating rooms under direct fluoroscopic control using fiberoptic or videooptic duodenoscopes.
: Seventeen men and nine women with a mean age of 32.8 +/- 2.2 years suffered severe abdominal trauma. ERCP was performed in these patients a mean of 19 +/- 11.3 days after trauma. Seven patients underwent ERCP just before or at laparotomy. Eight of 26 (31%) patients were found to have intact pancreatic and bile ducts, whereas 18 (69%) patients had substantial findings unsuspected by pre-ERCP imaging. Nine of these 18 patients with documented ductal injury underwent endoscopic treatment alone without further surgical intervention, including pancreatic sphincterotomies and/or pancreatic ductal stenting.
: ERCP is feasible and strongly indicated in the care of many patients with pancreatic trauma. Patient care and overall surgical and hospital needs may be substantially impacted by the use of both diagnostic and therapeutic endoscopic retrograde colongiopancreatography.

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Available from: Stanley Rogers, Oct 05, 2015
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    • "Huckfeldt et al. [11] reported the first successful stent placement when the procedure was performed a few hours after pancreatic trauma for MPD transection. Endoscopic transpapillary stenting of the MPD promotes healing of duct disruptions by blocking the leaking duct and bridging the disruption or by ablating the pancreatic sphincter converting the high-pressure pancreatic duct system to a low-pressure system with preferential flow to the duodenum [12,4]. Endoscopic transgastric drainage has been established for the treatment of peripancreatic fluid collections and pseudocysts after acute or chronic pancreatitis [13]. "
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    ABSTRACT: Introduction Pancreatic injury is uncommon and the management remains controversial. The integrity of the main pancreatic duct is considered the most important determinant for prognosis. Case presentation A 19-year-old Greek man was referred to our tertiary referral centre due to blunt abdominal trauma and an associated grade III pancreatic injury. He was haemodynamically stable and his initial treatment was conservative. Due to deterioration in his clinical symptomatology he underwent an endoscopy 20 days postinjury, where a stent was placed in the proximal pancreatic duct remnant and a bulging fluid collection of the lesser sac was drained transgastrically. He made an uneventful recovery and remains well 7 months postinjury, but a stricture with upstream dilatation of his main pancreatic duct has developed. Conclusions The clinical status of the patient rather than the grade of pancreatic injury should be the principal determinant to guide treatment. Endoscopic stenting and drainage is an attractive minimally invasive procedure and it may obviate the need for surgery. However, further investigation is required regarding the safety and outcome.
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  • The Journal of trauma 11/2010; 69(5):1011-21. DOI:10.1097/TA.0b013e3181f9c216 · 2.96 Impact Factor
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