NON OPERATIVE APPROACH TO COMPLETE PANCREATIC NECK TRANSECTION ; A CASE REPORT edabare@gmail.com

 

NON OPERATIVE APPROACH TO COMPLETE PANCREATIC NECK TRANSECTION ; A CASE REPORT

3

Sri Lanka

Oral or Poster

Pancreatic injuries are uncommon in trauma patients (0.5–8%) and are often associated with other abdominal organ injuries, making isolated pancreatic injuries rare (about 10%). The American Association for the Surgery of Trauma (AAST) classifies these injuries into five grades, with Grades IV and V involving severe parenchymal and ductal damage typically requiring surgery. This case report highlights a rare instance of an isolated Grade IV pancreatic injury that was successfully managed conservatively without surgical intervention.

Multidisciplinary team approach was taken in management of the patient. Conservative management included bowel rest, total parental nutrition and pain control. Pigtail catheter insertion was done on day 3 for hamatoma drainage and drain fluid amylase was 24,000 IU/L. ERCP for ductal stenting failed on day 14.

Patient was successfully managed conservatively without any residual effect from the injury.

Recent increase in tendency to manage pancreatic injuries conservatively needs further evaluation, specially in a resource poor setting such as within Sri Lanka, due to the sparsity of ICU facilities for close monitoring and unavailability of CT scan for serial imaging in most regions of the country. However, this case report highlights successful conservative management of a grade IV blunt pancreatic injury emphasizing the importance of concidering a conservative approach when feasible in high grade pancreatic injuries.