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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  1. 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. PMID: 2231822.
  2. Meier DE, Coln CD, Hicks BA, et al. Early operation in children with pancreas transection. J Pediatr Surg 2001;36(2):341–344. DOI: 10.1053/jpsu.2001.20711.
  3. Arkovitz MS, Johnson N, Garcia VF. Pancreatic trauma in children: Mechanisms of injury. J Trauma 1997;42(1):49–53. DOI: 10.1097/ 00005373-199701000-00009.
  4. Wales PW, Shuckett B, Kim PC. Long-term outcome after nonoperative management of complete traumatic pancreatic transection in children. J Pediatr Surg 2001;36(5):823–827. DOI: 10.1053/jpsu.2001. 22970.
  5. de Blaauw I, Winkelhorst JT, Rieu PN, et al. Pancreatic injury in children: Good outcome of nonoperative treatment. J Pediatr Surg 2008;43(9):1640–1643. DOI: 10.1016/j.jpedsurg.2008.03.061.
  6. 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.
  7. Nikfarjam M, Rosen M, Ponsky T. Early management of traumatic pancreatic transection by spleen-preserving laparoscopic distal pancreatectomy. J Pediatr Surg 2009;44(2):455–458. DOI: 10.1016/j.jpedsurg.2008.09.026.
  8. Rutkoski JD, Segura BJ, Kane TD. Experience with totally laparoscopic distal pancreatectomy with splenic preservation for pediatric trauma-2 techniques. J Pediatr Surg 2011;46(3):588–593. DOI: 10.1016/j.jpedsurg.2010.07.020.
  9. Nadler EP, Gardner M, Schall LC, et al. Management of blunt pancreatic injury in children. J Trauma 1999;47(6):1098–1103. DOI: 10.1097/00005373-199912000-00020.
  10. Adam JP, Jacquin A, Laurent C, et al. Laparoscopic spleen-preserving distal pancreatectomy: Splenic vessel preservation compared with the Warshaw technique. JAMA Surg 2013;148(3):246. DOI: 10.1001/jamasurg.2013.768.
  11. Ho VP, Patel NJ, Bokhari F, et al. Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg 2017;82(1):185–199. DOI: 10.1097/TA.0000000000001300.
  12. Schellenberg M, Inaba K, Cheng V, et al. Spleen-preserving distal pancreatectomy in trauma. J Trauma Acute Care Surg 2018;84(1):118–122. DOI: 10.1097/TA.0000000000001725.
  13. Dardenne S, Sterkers A, Leroy C, et al. Laparoscopic spleen-preserving distal pancreatectomy followed by intramuscular autologous islet transplantation for traumatic pancreatic transection in a young adult. JOP 2012;13(3):285–288. PMID: 22572133.
  14. Anadolulu Aİ, Kafadar MT, Gök MA, et al. Laparoscopic spleen-preserving distal pancreatectomy with splenic vessel preservation for pancreatic pseudocyst in a 10-year-old boy. Journal of Pediatric Surgery Case Reports 2018;34:10–12. DOI: 10.1016/j.epsc.2018.04.011.
  15. Malek MM, Shah SR, Kane TD. Video. Laparoscopic splenic-preserving distal pancreatectomy for trauma in a child. Surg Endosc 2010;24(10):2623. DOI: 10.1007/s00464-010-0961-x.
  16. Reynolds EM, Curnow AJ. Laparoscopic distal pancreatectomy for traumatic pancreatic transection. J Pediatr Surg. 2003;38(10):E7–E9. DOI: 10.1016/s0022-3468(03)00519-0.
  17. de Wilt JHW, Eijck CHJ van, Hussain SM, et al. Laparoscopic spleen preserving distal pancreatectomy after blunt abdominal trauma. Injury 2003;34(3):233–234. DOI: 10.1016/s0020-1383(02)00261-9.
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