Tailored Endoscopic Approaches for Pancreatic Traumatic Injuries.
Pancreatic traumatic injuries should be managed by multidisciplinary
approach. Standard redo surgery can be avoided or supported by innovative
mininvasive approaches both endoscopically and/or radiologically. Pancreatic endotherapy
has an increasing role
in the management of pancreatic injuries.
Endoscopic treatment must be tailored on the type and site of pancreatic
fistula to achieve the optimal clinical outcome: there is
not a one-way standard treatment but the best treatment for different types
of pancreatic injuries considering both retrograde and
endoscopic ultrasound-guided approaches.
Pancreatic injuries during abdominal trauma account for 4-5%
of major traumas. This type of injury can be very difficult to
diagnose.
A delay in diagnosis can lead to several complications
such as infections, pseudocysts, abscesses, duct strictures, pancreatic ascites
which are associated with high morbidity and mortality. Furthermore,
incorrect classification limits proper intervention
and management.
Multiple pancreatic injury grading systems have been
proposed, one of the best known being the American Association
for the Surgery of Trauma classification, which divided
five grades on the basis of parenchymal, main vessel and duct damage.
Pancreatic duct leaks and fistulas can lead to significant
morbidity and mortality. Traditionally, pancreatic fistulas are managed
conservatively by fluid drainage, supportive therapy, total
parenteral nutrition and pancreatic secretion inhibitors.
However, there has recently been a trend toward aggressive yet
minimally invasive management, to
avoid surgery. Endoscopic
transpapillary or transmural drainage of pancreatic collections/
leaks is now increasingly performed, also in this setting.
Pancreas Open J. 2022; 5(1): 16-17. doi: 10.17140/POJ-5-115