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Regional injuries and patterns of injury
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
The forces generally required to cause these injuries in an adult are severe and they are commonly encountered in road traffic collisions. In an otherwise healthy adult, it would be unusual but not impossible for a simple punch to the abdomen to cause significant intra-abdominal injuries, but kicks and stamps are commonly the cause of major trauma. The kidneys and the spleen are attached only by their hila and are susceptible not only to direct trauma but also to rotational and shearing forces that may result in avulsion from their vascular pedicles. Blunt trauma to the spleen is sometimes associated with delayed rupture leading to haemorrhage and possibly death some hours or even days after the injury. Pancreatic trauma can cause fatal pancreatitis or peritonitis, although sometimes may lead to the development of a pseudocyst, with little or no short-term or long-term sequelae. Once diagnosed the successful treatment of these conditions may be conservative or surgical. The best opportunity of survival for many of these conditions is immediate assessment, diagnosis and resuscitation.
The Abdomen
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Management varies from simple drainage to highly challenging procedures depending on the severity, the site of the injury, and the integrity of the duct. Accurate intra-operative investigation of the pancreatic duct is particularly challenging. To compound this, pancreatic trauma is associated with a high incidence of injury to adjoining organs (duodenum, kidney, liver) and major vascular structures, which adds to the high morbidity and mortality.1The surgeon must always be critically aware of the patient's changing physiological state and be prepared to forsake the technical challenge of definitive repair for life-saving damage control.
The pancreas
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Blunt pancreatic trauma usually presents with epigastric pain, which may be minor at first, with the progressive development of more severe pain due to the sequelae of leakage of pancreatic fluid into the surrounding tissues. The clinical presentation can be quite deceptive; careful serial assessments and a high index of suspicion are required. A rise in serum amylase occurs in most cases. A CT scan of the pancreas will delineate the damage that has occurred to the pancreas (Figure68.21). If there is doubt about duct disruption, an urgent ERCP should be sought. MRCP may also provide the answer, but the images can be difficult to interpret. Support with intravenous fluids and a ‘nil by mouth' regimen should be instituted while these investigations are performed. There is no need to rush to a laparotomy if the patient is haemodynamically stable, without peritonitis. It is preferable to manage conservatively at first, investigate and, once the extent of the damage has been ascertained, undertake appropriate action. Operation is indicated if there is disruption of the main pancreatic duct; in almost all other cases, the patient will recover with conservative management.
Recognizing and Managing Pancreaticopleural Fistulas in Children
Published in Journal of Investigative Surgery, 2022
Konstantina Dimopoulou, Anastasia Dimopoulou, Nikolaos Koliakos, Andrianos Tzortzis, Dimitra Dimopoulou, Nikolaos Zavras
Reports in the literature of PPF in children, especially before adolescence, arescant. Chronic pancreatitis in pediatric patients may be caused by structural and biliary abnormalities, drug-induced damage, hypercalcemia, hyperlipidemia, cystic fibrosis, vasculitis, a-1-antitrypsin deficiency, juvenile tropical pancreatitis, and hereditary pancreatitis; calcific pancreatitis is a rare entity in childhood [3,4]. Furthermore, PPF can appear in children after blunt pancreatic trauma or iatrogenic injury following endoscopic retrograde cholangiopancreatography (ERCP) or surgery involving either the pancreas or adjacent organs and structures [5–7]. It is crucial that the etiology of PPF be determined, in order to design optimal and efficient strategies and plan long-term follow-up.