Resectional versus conservative surgery for blunt pancreatic trauma: a cross-sectional study from the eastern region of Nepal

Background: Blunt pancreatic trauma is relatively uncommon but carries high morbidity and mortality rates, when diagnosis is delayed. High-grade injury can be managed by both pancreatic resection or by conservative surgery (if required) depending on the clinical stability and time to diagnosis. Materials and methods: The clinical details and treatment outcome of 14 patients with pancreatic transection or laceration with or without main pancreatic duct (MPD) injury caused by blunt abdominal trauma were analyzed. The average age of the 14 patients (13 males, 1 female) was 22.4 years (range 5–51). Eight patients (57%) presented early (<24 hours), and six patients (43%) presented late (>24 hours) following trauma. Results: Ten patients had isolated pancreatic trauma. High-grade and low-grade injuries were observed in 12 and two patients, respectively. Eight (57%) patients were clinically unstable at the time of presentation. Seven of them with MPD injury underwent immediate resectional surgery (distal pancreatectomy with or without spleen preservation). One patient required concomitant duodenal diverticulization for duodenal (D1) transection. One young boy who had grade II pancreatic injury but with peritonitis underwent closed lesser sac drainage. Conservative surgery was done in six patients including early and delayed. Four patients (isolated grade III pancreatic injury) underwent conservative surgery for late complications/sequelae: cyst-enteric drainage ( n = 3) for pancreatic pseudocyst and lateral pancreato-jejunostomy ( n = 1) for disconnected pancreatic duct syndrome. One patient with low-grade injury underwent non-operative management. There was single operative mortality. Conclusion: High-grade pancreatic injury with ductal transection can be managed by resectional surgery or by conservative surgery depending on the time to presentation and clinical stability, with a similar treatment outcome.