The management of complex pancreatic injuries

 

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dc.contributor.author Krige, J E J
dc.contributor.author Beningfield, S J
dc.contributor.author Nicol, A J
dc.contributor.author Navsaria, P
dc.date.accessioned 2016-10-03T10:05:24Z
dc.date.available 2016-10-03T10:05:24Z
dc.date.issued 2005
dc.identifier.citation Krige, J. E. J., Beningfield, S. J., Nicol, A. J., & Navsaria, P. (2005). The management of complex pancreatic injuries. South African Journal of Surgery, 43(3), 92-102.
dc.identifier.uri http://hdl.handle.net/11427/22070
dc.description.abstract Major injuries of the pancreas are uncommon, but may result in considerable morbidity and mortality because of the magnitude of associated vascular and duodenal injuries or underestimation of the extent of the pancreatic injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, speed of resuscitation and quality and nature of surgical intervention. Early mortality usually results from uncontrolled or massive bleeding due to associated vascular and adjacent organ injuries. Late mortality is a consequence of infection or multiple organ failure. Neglect of major pancreatic duct injury may lead to life-threatening complications including pseudocysts, fistulas, pancreatitis, sepsis and secondary haemorrhage. Careful operative assessment to determine the extent of gland damage and the likelihood of duct injury is usually sufficient to allow planning of further management. This strategy provides a simple approach to the management of pancreatic injuries regardless of the cause. Four situations are defined by the extent and site of injury: (i) minor lacerations, stabs or gunshot wounds of the superior or inferior border of the body or tail of the pancreas (i.e. remote from the main pancreatic duct), without visible duct involvement, are best managed by external drainage; (ii) major lacerations or gunshot or stab wounds in the body or tail with visible duct involvement or transection of more than half the width of the pancreas are treated by distal pancreatectomy; (iii) stab wounds, gunshot wounds and contusions of the head of the pancreas without devitalisation of pancreatic tissue are managed by external drainage, provided that any associated duodenal injury is amenable to simple repair; and (iv) non-reconstructable injuries with disruption of the ampullary-biliary-pancreatic union or major devitalising injuries of the pancreatic head and duodenum in stable patients are best treated by pancreatoduodenectomy. Internal drainage or complex defunctioning procedures are not useful in the emergency management of pancreatic injuries, and can be avoided without increasing morbidity. Unstable patients may require initial damage control before later definitive surgery. Successful treatment of complex injuries of the head of the pancreas depends largely on initial correct assessment and appropriate treatment. The management of these severe proximal pancreatic injuries remains one of the most difficult challenges in abdominal trauma surgery, and optimal results are most likely to be obtained by an experienced multidisciplinary team.
dc.language.iso eng
dc.source South African Journal of Surgery
dc.source.uri http://sajs.co.za/
dc.title The management of complex pancreatic injuries
dc.type Report en_ZA
dc.date.updated 2016-01-05T09:47:30Z
uct.type.resource Research en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Department of Surgery en_ZA
uct.type.filetype Text
uct.type.filetype Image
dc.identifier.apacitation Krige, J. E. J., Beningfield, S. J., Nicol, A. J., & Navsaria, P. (2005). <i>The management of complex pancreatic injuries</i> University of Cape Town ,Faculty of Health Sciences ,Department of Surgery. Retrieved from http://hdl.handle.net/11427/22070 en_ZA
dc.identifier.chicagocitation Krige, J E J, S J Beningfield, A J Nicol, and P Navsaria <i>The management of complex pancreatic injuries.</i> University of Cape Town ,Faculty of Health Sciences ,Department of Surgery, 2005. http://hdl.handle.net/11427/22070 en_ZA
dc.identifier.vancouvercitation Krige JEJ, Beningfield SJ, Nicol AJ, Navsaria P. The management of complex pancreatic injuries. 2005 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/22070 en_ZA
dc.identifier.ris TY - Report AU - Krige, J E J AU - Beningfield, S J AU - Nicol, A J AU - Navsaria, P AB - Major injuries of the pancreas are uncommon, but may result in considerable morbidity and mortality because of the magnitude of associated vascular and duodenal injuries or underestimation of the extent of the pancreatic injury. Prognosis is influenced by the cause and complexity of the pancreatic injury, the amount of blood lost, duration of shock, speed of resuscitation and quality and nature of surgical intervention. Early mortality usually results from uncontrolled or massive bleeding due to associated vascular and adjacent organ injuries. Late mortality is a consequence of infection or multiple organ failure. Neglect of major pancreatic duct injury may lead to life-threatening complications including pseudocysts, fistulas, pancreatitis, sepsis and secondary haemorrhage. Careful operative assessment to determine the extent of gland damage and the likelihood of duct injury is usually sufficient to allow planning of further management. This strategy provides a simple approach to the management of pancreatic injuries regardless of the cause. Four situations are defined by the extent and site of injury: (i) minor lacerations, stabs or gunshot wounds of the superior or inferior border of the body or tail of the pancreas (i.e. remote from the main pancreatic duct), without visible duct involvement, are best managed by external drainage; (ii) major lacerations or gunshot or stab wounds in the body or tail with visible duct involvement or transection of more than half the width of the pancreas are treated by distal pancreatectomy; (iii) stab wounds, gunshot wounds and contusions of the head of the pancreas without devitalisation of pancreatic tissue are managed by external drainage, provided that any associated duodenal injury is amenable to simple repair; and (iv) non-reconstructable injuries with disruption of the ampullary-biliary-pancreatic union or major devitalising injuries of the pancreatic head and duodenum in stable patients are best treated by pancreatoduodenectomy. Internal drainage or complex defunctioning procedures are not useful in the emergency management of pancreatic injuries, and can be avoided without increasing morbidity. Unstable patients may require initial damage control before later definitive surgery. Successful treatment of complex injuries of the head of the pancreas depends largely on initial correct assessment and appropriate treatment. The management of these severe proximal pancreatic injuries remains one of the most difficult challenges in abdominal trauma surgery, and optimal results are most likely to be obtained by an experienced multidisciplinary team. DA - 2005 DB - OpenUCT DP - University of Cape Town J1 - South African Journal of Surgery LK - https://open.uct.ac.za PB - University of Cape Town PY - 2005 T1 - The management of complex pancreatic injuries TI - The management of complex pancreatic injuries UR - http://hdl.handle.net/11427/22070 ER - en_ZA


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