2000, Number 3
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ABSTRACTObjective: To provide information on the diagnostic concepts and timely treatment options for pancreato-duodenal traumatisms.
Data collection: Review of the international literature on the subject (16 references).
Selection of data: The most relevant articles related to pancreato-duodenal traumatisms were chosen; their application in a general surgery ward was analyzed.
Results: Traumatic lesions of the pancreas and duodenum still represent a challenge to the clinical judgment and the surgical ability of the trauma surgeon, especially when dealing with combined lesions. On one hand, their location in the retroperitoneum and, on the other, their tight relation with important intra-abdominal structures widen its spectrum of presentation. The significant immediate mortality related to the associated lesions and the severe complications that can develop due to an inadequate handling require that the surgeon be aware of these lesions to be able to provide a timely and adequate treatment. The Central Military hospital, due to its characteristics, treats a large amount of polytraumatized patients. Due to the particular characteristics of the patient with pancreato-duodenal trauma, a protocol was established for its diagnosis and timely treatment.
Conclusion: The aim of the protocol is to familiarize the surgeon with the data that might indicate the presence of a pancreato-duodenal lesion. Studies must be performed to establish or confirm the diagnosis and to select the surgical alternative available for each particular case.
Rigon R, Trevisan P, Giacomazzi A. Traumi del pancreas: evenienza rara ma temibile. Minerva Chir 1994; 49: 509-14.
Sukul K, Lont HE, Johaness EJ. Management of pancreatic injuries. Hepatogastroenterology 1992; 39: 447-50.
Smego DR, Richardson JD, Flint LM. Determinants of outcome in pancreatic trauma. J Trauma 1985; 25: 771-6.
Asensio JA, Feliciano DV, Britt LD, Kerstein MD. Management of duodenal injuries. Curr Probl Surg 1993; 30: 1023-93.
Heimansohn DA, Canal DF, McCarthy MC, Yaw PB, Madura JA, Broadie TA. The role of pancreaticoduodenectomy in the management of traumatic injuries to the pancreas and duodenum. Am Surg 1990; 56: 511-4.
Mansour MA, Moore JB, Moore EE, Moore FA. Conservative management of combined pancreatoduodenal injuries. Am J Surg 1989; 158: 531-5.
Cogbill TH, Moore EE, Morris JA Jr, Hoyt DB, Jurkovich GJ, Mucha P Jr, et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991; 31: 1600-6.
Wilson RH, Moorehead RJ. Current management of trauma to the pancreas. Br J Surg 1991; 78: 1196-202.
Oreskovich MR, Carrico CJ. Pancreaticoduodenectomy for trauma: a viable option? Am J Surg 1984; 147: 618-23.
Flynn WJ Jr, Cryer HG, Richardson JD. Reappraisal of pancreatic and duodenal injury management based in injury severity. Arch Surg 1990; 125: 1539-41.
Feliciano DV, Martin TD, Cruse PA, Graham JM, Burch JM, Mattox KL, et al. Management of combined pancreatoduodenal injuries. Ann Surg 1987; 205: 673-9; discussion 679-80.
Ivatury RR, Nallathambi M, Rao P, Sthal WM. Penetrating pancreatic injuries. Analysis of 103 consecutive cases. Am Surg 1990; 56: 90-5.
Heyse-Moore GH. Blunt pancreatic and pancreaticoduodenal trauma. Br J Surg 1976; 63: 226-8.
Fabian TC, Kudsk KA, Croce MA, Payne LW, Mangiante EC, Voeller GR, et al. Superiority of closed suction drainage for pancreatic trauma. A randomized, prospective study. Ann Surg 1990; 211: 724-8; discussion 728-30.
Cogbill TH, Moore EE, Feliciano DV, Hoyt DB, Jurkovich GJ, Morris JA, et al. Conservative management of duodenal trauma: a multicenter perspective. J Trauma 1990; 30: 1469-75.
Jurkovich GJ, Carrico CJ. Pancreatic trauma. Surg Clin North Am 1990; 70: 575-93.