Conservative Versus Operative Management for Pancreatic Trauma in Adult Patients: a Retrospective Analysis

Introduction: The management of pancreatic trauma is complex, with several strategies for a successful therapeutic management. The aim of this retrospective study was to report our experience in the management of pancreatic trauma. Methods: All patients hospitalized between 2005 and 2013 for pancreatic trauma were included. Traumatic injuries of the pancreas were classified according to the American Association for Surgery of Trauma in 5 grades: grade 1: minor contusion without duct injury; grade 2: major contusion without duct injury or tissue loss; grade 3: distal transection of the pancreas with ductal injury; grade 4: proximal transection or parenchymal injury involving the ampulla; and grade 5: massive destruction of the pancreatic head. Mortality and morbidity were analyzed. Results: A total of 30 patients were analyzed (mean age: 38 ± 17 years). Nineteen (63%) patients had a blunt trauma and 11 (37%) patients had pancreatic injury ≥ grade 3. Fifteen patients underwent exploratory laparotomy and the other 15 patients had nonoperative management. Four (13%) patients had a partial pancreatectomy [distal pancreatectomy (n = 3) and pancreaticoduodenectomy (n = 1)]. Overall, in-hospital mortality was 20% (n = 6). Postoperative mortality was 27% (n = 4/15). Mortality of nonoperative treatment was 13% (n = 2/15). Conclusion: The risk of mortality is two times higher in case of laparotomy. Distal pancreatectomy is advocated for body and tail injury while conservative treatment is preferred in the cases of pancreatic head injury.