World Journal of Laparoscopic Surgery

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VOLUME 15 , ISSUE 3 ( September-December, 2022 ) > List of Articles

CASE REPORT

Laparoscopic Spleen-preserving Distal Pancreatectomy for Grade III Pancreatic Injury: A Case Report

Murugappan Nachiappan, Ravikiran Thota, Srikanth Gadiyaram

Keywords : Duct disruption, Laparoscopy, Pancreas, Trauma

Citation Information : Nachiappan M, Thota R, Gadiyaram S. Laparoscopic Spleen-preserving Distal Pancreatectomy for Grade III Pancreatic Injury: A Case Report. World J Lap Surg 2022; 15 (3):262-265.

DOI: 10.5005/jp-journals-10033-1542

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim: This article reports a case of grade III pancreatic injury managed by laparoscopic spleen-preserving distal pancreatectomy (SPDP). It also discusses the management options available, the timing of surgery, and the surgical options with the review of available literature. Background: Pancreatic surgery represents one of the most challenging areas in gastrointestinal surgery. Isolated pancreatic injury is uncommon following abdominal trauma. Pancreatic transection with duct disruption following blunt abdominal trauma could be managed by both conservative and surgical approaches. Complete pancreatic transection with duct disruption carries high morbidity and mortality. Distal pancreatic resection along with splenectomy is the preferred surgical procedure. Laparoscopic distal pancreatectomy has gained worldwide acceptance in recent years for non-traumatic cases. We report a case of grade III pancreatic injury in a 15-year-old girl managed with laparoscopic SPDP. Case description: A 15-year-old girl presented to us with around 24 hours of blunt trauma to the upper abdomen. She was hemodynamically stable. On examination abdomen was tender and there was voluntary guarding. Evaluation with contrast-enhanced computed tomography (CECT) showed grade III pancreatic injury. There was no pneumoperitoneum. The rest of the solid organs were normal. After resuscitation in line with advanced trauma life support (ATLS) protocols, she underwent a laparoscopic SPDP after written informed consent. She made an uneventful recovery and was discharged on the sixth postoperative day. At the last follow-up, eight years after the surgery, she had no symptoms of endocrine or exocrine insufficiency. Conclusion: Laparoscopic SPDP for pancreatic trauma, though technically demanding and time-consuming, is a feasible undertaking in hemodynamically stable patients. Clinical significance: This case highlights that SPDP for grade III pancreatic injury could be accomplished laparoscopically. A minimally invasive approach is feasible in patients with no associated injuries and hemodynamic stability. Early diagnosis and surgical management are crucial for optimal outcomes.


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