Panamerican Journal of Trauma, Critical Care & Emergency Surgery

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VOLUME 9 , ISSUE 1 ( January-April, 2020 ) > List of Articles

Original Article

Damage Control Pancreatoduodenectomy for Severe Pancreaticoduodenal Trauma: A Multicentric Case Series in Colombia

Luis F Cabrera, Mauricio Pedraza, Sebastian Sanchez, Paula Lopez, Felipe Bernal, Jean Pulido, Patricia Parra, Carlos Lopez, Luis M Marroquin, Juliana Ordoñez, Gabriel Herrera

Keywords : Abdominal trauma, Advanced trauma life support care, Duodenum, Multiple trauma, Pancreas, Trauma severity indices

Citation Information : Cabrera LF, Pedraza M, Sanchez S, Lopez P, Bernal F, Pulido J, Parra P, Lopez C, Marroquin LM, Ordoñez J, Herrera G. Damage Control Pancreatoduodenectomy for Severe Pancreaticoduodenal Trauma: A Multicentric Case Series in Colombia. Panam J Trauma Crit Care Emerg Surg 2020; 9 (1):38-44.

DOI: 10.5005/jp-journals-10030-1266

License: CC BY-NC 4.0

Published Online: 01-04-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Emergency pancreatoduodenectomy is a procedure that is indicated for the management of severe pancreaticoduodenal trauma after damage control surgery. Objectives: To present our experience of pancreaticoduodenal trauma management with emergency pancreatoduodenectomy and damage control surgery. Materials and methods: Retrospectively recorded data of patients with severe pancreaticoduodenal trauma who underwent a pancreatoduodenectomy and damage control for trauma at a high-volume trauma center. Results: In a period of 6 years, four patients (three men and one woman, median age 17.5 years, range: 16–21 years) with severe pancreaticoduodenal trauma underwent a pancreatoduodenectomy and damage control procedure (gunshot n = 4), and in a second surgical procedure underwent gastrointestinal tract reconstruction. In total, 75% incidence of surgical site infection (SSI) was reported, 25% health-care-associated pneumonia, and 50% postoperative pancreatic fistula (POPF). Intensive care unit (ICU) of 12.25 and hospital stay of 29.5 days mean and no mortality. Conclusion: An emergency pancreatoduodenectomy can be a lifesaving procedure in patients with non-reconstructable duodenopancreatic injuries. Damage control surgery in pancreaticoduodenal trauma is an alternative for management although with high risk of morbidity.


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  1. Asensio JA, Petrone P, Roldán G, et al. Pancreatic and duodenal injuries. Complex and lethal. Scand J Surg 2002;91(1):81–86. DOI: 10.1177/145749690209100113.
  2. Vane D, Kiankhooy A, Sartorelli K, et al. Initial resection of potentially viable tissue is not optimal treatment for grades II–IV pancreatic injuries. World J Surg 2009;33(2):221–227. DOI: 10.1007/s00268-008-9569-x.
  3. Asensio JA, Demetriades D, Berne JD, et al. A unified approach to the surgical exposure of pancreatic and duodenal injuries. Am J Surg 1997;174(1):54–60. DOI: 10.1016/S0002-9610(97)00029-9.
  4. Leitmeyer K, Adlhoch C, Sharma A. Management of pancreaticoduodenal injuries. Epidemiology 2016;27(5):743–751. DOI: 10.1097/EDE.0000000000000438.
  5. Blocksom JM, Tyburski JG, Sohn RL, et al. Prognostic determinants in duodenal injuries. Am Surg 2004;70(3):248–255.
  6. Potoka DA, Gaines BA, Leppäniemi A, et al. Management of blunt pancreatic trauma: What's new? Eur J Trauma Emerg Surg 2015;41(3):239. DOI: 10.1007/s00068-015-0510-3.
  7. Oreskovich MR, Carrico CJ. Pancreatoduodenectomy for trauma: a viable option? Am J Surg 1984;147(5):618–623. DOI: 10.1016/0002-9610(84)90126-0.
  8. Chrysos E, Athanasakis E, Xynos E. Pancreatic trauma in the adult: current knowledge in diagnosis and management. Pancreatology 2002;2(4):365–378. DOI: 10.1159/000065084.
  9. Lin BC, Chen RJ, Fang JF, et al. Management of blunt major pancreatic injury. J Trauma 2004;56(4):774–778. DOI: 10.1097/01.ta.0000087644.90727.df.
  10. Krige JE, Nicol AJ, Navsaria PH. Emergency pancreatoduodenectomy for complex injuries of the pancreas and duodenum. HPB (Oxford) 2014;16(11):1043–1049. DOI: 10.1111/hpb.12244.
  11. Krige JE, Bornman PC, Terblanche J. The role of pancreatoduodenectomy in the management of complex pancreatic trauma. In: Hanyu F, Takasaki K. Pancreatoduodenectomy. Tokyo: Springer-Verlag; 1997. pp. 49–62.
  12. Krige JE, Beningfield SJ, Nicol AJ, et al. The management of complex pancreatic injuries. S Afr J Surg 2005;43(3):92–102.
  13. Thompson CM, Shalhub S, DeBoard ZM, et al. Revisiting the pancreaticoduodenectomy for trauma. J Trauma Acute Care Surg 2013;75(2):225–228. DOI: 10.1097/ta.0b013e31829a0aaf.
  14. Krige JE, Kotze UK, Hameed M, et al. Pancreatic injuries after blunt abdominal trauma: an analysis of 110 patients treated at a level 1 trauma centre. S Afr J Surg 2011;49(2):58, 60, 62–64.
  15. Moore EE, Cogbill TH, Malangoni MA, et al. Organ injury scaling, II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma 1990;30(11):1427–1429. DOI: 10.1097/00005373-199011000-00035.
  16. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 2009;250(2):187–196. DOI: 10.1097/SLA.0b013e3181b13ca2.
  17. Bassi C, Dervenis C, Butturini G, et al. International study group on pancreatic fistula definition. Post-operative pancreatic fistula: An international study group (ISGPF) definition. Surgery 2005;138(1):8–13. DOI: 10.1016/j.surg.2005.05.001.
  18. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM consensus conference committee. American college of chest physicians/society of critical care medicine. Chest 1992;101(6):1644–1655. DOI: 10.1378/chest.101.6.1644.
  19. Moore FA, Sauaia A, Moore EE, et al. Postinjury multiple organ failure: A bimodal phenomenon. J Trauma 1996;40(4):501–510. DOI: 10.1097/00005373-199604000-00001.
  20. Krige JEJ, Kotze UK, Nicol AJ, et al. Morbidity and mortality after distal pancreatectomy for trauma: a critical appraisal of 107 consecutive patients undergoing resection at a level 1 trauma centre. Injury 2014;45(9):1401–1408. DOI: 10.1016/j.injury.2014.04.024.
  21. Scollay JM, Yip VS, Garden OJ, et al. A population-based study of pancreatic trauma in Scotland. World J Surg 2006;30(12):2136–2141. DOI: 10.1007/s00268-006-0039-z.
  22. Mansour MA, Moore JB, Moore EE, et al. Conservative management of combined pancreatoduodenal injuries. Am J Surg 1989;158(6): 531–535. DOI: 10.1016/0002-9610(89)90185-2.
  23. Are C, Dhir M, Ravipati L. History of pancreaticoduodenectomy: early misconceptions, initial milestones and the pioneers. HPB (Oxford) 2011;13(6):377–384. DOI: 10.1111/j.1477-2574.2011.00305.x.
  24. Debi U, Kaur R, Prasad KK, et al. Pancreatic trauma: a concise review. World J Gastroenterol 2013;19(47):9003. DOI: 10.3748/wjg.v19.i47.9003.
  25. Schnelldorfer T. Alessandro codivilla and the first pancreatoduodenectomy. Arch Surg 2009;144(12):1179. DOI: 10.1001/archsurg.2009.219.
  26. Bernal F, Sánchez S, Pedraza M, et al. Pancreatoduodenectomía de urgencia: whipple o no whipple, esa es la cuestión. Rev Colomb Cir 2018;33(1):111–118. DOI: https://doi.org/10.30944/20117582.53.
  27. Van der Wilden GM, Yeh DD, Hwabejire JO, et al. Trauma whipple: Do or don't after severe pancreaticoduodenal injuries? an analysis of the national trauma data bank (NTDB). World J Surg 2014;38(2):335e340. DOI: 10.1007/s00268-013-2257-5PMID: 24121363.
  28. Petrone P, Moral S, González M, et al. Pancreatic trauma: management and literature review. Cir Esp 2017;95(3):123–130. DOI: 10.1016/j.ciresp.2016.05.011.
  29. Seamon MJ, Kim PK, Stawicki SP, et al. Pancreatic injury in damage control laparotomies: is pancreatic resection safe during the initial laparotomy? Injury 2009;40(1):61–65. DOI: 10.1016/j.injury.2008.08.010.
  30. Wang GF, Li YS, Li JS. Damage control surgery for severe pancreatic trauma. Hepatobiliary Pancreat Dis Int 2007;6(6):569–571.
  31. Nicol AJ, Navsaria PH, Krige JE. Damage control surgery. S Afr J Surg 2010;48(1):4–5.
  32. Pereira J, Aveiro D, Constantino J, et al. Trauma pancreatoduodenectomy: How and why? Case Rep Int 2015;4:57–61.
  33. Di Saverio S, Segalini E, Birindelli A, et al. Pancreas-sparing, ampulla-preserving duodenectomy for major duodenal (D1–D2) perforations. Br J Surg 2018;105(11):1487–1492. DOI: 10.1002/bjs.10910.
  34. Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349(22):2117. DOI: 10.1056/NEJMsa035205.
  35. Hüttner FJ, Fitzmaurice C, Schwarzer G, et al. Pylorus-preserving pancreatico-duodenectomy (pp whipple) versus pancreaticoduodenectomy (classic whipple) for surgical treatment of periampullary and pancreatic carcinoma. Cochrane Database Syst Rev 2016;2:CD006053. DOI: 10.1002/14651858.CD006053. pub6.
  36. Asensio JA, Demetriades D, Hanpeter DE, et al. Management of pancreatic injuries. Curr Probl Surg 1999;36(5):325. DOI: 10.1016/s0011-3840(99)80003-3.
  37. Rotondo MF, Schwab CW, McGonigal MD, et al. “DAMAGE control”: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma 1993;35(3):375–383. DOI: 10.1097/00005373-199309000-00008.
  38. Koniaris LG. Role of pancreatectomy after severe pancreaticoduodenal trauma. J Am Coll Surg 2004;198(4):677–678. DOI: 10.1016/j.jamcollsurg.2004.01.014.
  39. Gulla A, Tan WP, Pucci MJ, et al. Emergent pancreaticoduodenectomy: a dual institution experience and review of the literature. J Surg Res 2014;186(1):1–6. DOI: 10.1016/j.jss.2013.07.057.
  40. Asensio JA, Petrone P, Roldán G, et al. Pancreaticoduodenectomy: a rare procedure for the management of complex pancreaticoduodenal injuries. J Am College Surg 2003;197(6):937–942. DOI: 10.1016/j.jamcollsurg.2003.07.019.
  41. Lissidini G, Prete FP, Piccinni G, et al. Emergency pancreaticoduodenectomy: When is it needed? A dual non-trauma centre experience and literature review. Int J Surg 2015;21(Suppl. 1): S83–S88. DOI: 10.1016/j.ijsu.2015.04.096.
  42. Tianjin C, Hong G, Zhangying W, et al. The diagnosis and treatment of pancreas injury: A report of 26 cases. J Traumatic Stress Disor Treat 2016(01):5. DOI: 10.4172/2324-8947.1000153.
  43. Bennett S, Amath A, Knight H, et al. Conservative versus operative management in stable patients with penetrating abdominal trauma: the experience of a canadian level 1 trauma centre. Can J Surg 2016;59(5):317–321. DOI: 10.1503/cjs.015615.
  44. Berne CJ, Donovan AJ, Hagen WE. Combined duodenal pancreatic trauma the role of end-to-side gastrojejunostomy. Arch Surg 1968;96(5):712–722. DOI: 10.1001/archsurg.1968.01330230020004.
  45. Cirocchi R, Montedori A, Farinella E, et al. Damage control surgery for abdominal trauma. Cochrane Database Syst Rev 2013(3):CD007438. DOI: 10.1002/14651858.CD007438.pub3.
  46. Kleeff J, Diener MK, Z'graggen K, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg 2007;245(4):573–582. DOI: 10.1097/01.sla.0000251438.43135.fb.
  47. Fitzgibbons TJ, Yellin AE, Maruyama MM, et al. Management of the transected pancreas following distal pancreatectomy. Surg Gynecol Obstet 1982;154(2):225–231.
  48. Knaebel HP, Diener MK, Wente MN, et al. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg 2005;92(5):539–546. DOI: 10.1002/bjs.5000.
  49. Malgras B, Douard R, Siauve N, et al. Management of left pancreatic trauma. Am Surg 2011;77(1):1–9.
  50. Cogbill TH, Moore EE, Morris JA Jr, et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma 1991;31(12):1600–1606. DOI: 10.1097/00005373-199112000-00006.
  51. Asensio A, Petrone P, Kimbrell B, et al. Trauma duodenal. Técnica y manejo Rev Colomb Cir 2006;21:4–14.
  52. Jensen EH, Portschy PR, Chowaniec J, et al. Meta-analysis of bioabsorbable staple line reinforcement and risk of fistula following pancreatic resection. J Gastrointest Surg 2013 Feb;17(2):267–272. DOI: 10.1007/s11605-012-2016-1.
  53. Degiannis E, Levy RD, Potokar T, et al. Distal pancreatectomy for gunshot injuries of the distal pancreas. Br J Surg 1995;82(9):1240–1242. DOI: 10.1002/bjs.1800820927.
  54. Sharpe JP, Magnotti LJ, Weinberg JA, et al. Impact of a defined management algorithm on outcome after traumatic pancreatic injury. J Trauma Acute Care Surg 2012;72(1):100–105. DOI: 10.1097/TA.0b013e318241f09d.
  55. Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin North Am 2007;87(6):1515–1532. DOI: 10.1016/j.suc.2007.08.007.
  56. Ahmed N, Vernick JJ. Pancreatic injury. South Med J 2009;102(12): 1253–1256. DOI: 10.1097/SMJ.0b013e3181c0dfca.
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