Complete major pancreatic duct disruption complicated by pancreatico-atmospheric fistula following blunt upper abdominal trauma

Shafic Abdulkarim, Saud Aldeghaither, Dan L Deckelbaum

Abstract


Pancreatic injury post blunt abdominal trauma is exceedingly rare. When complete major pancreatic duct (MPD) disruption occurs, a disconnection between the pancreas and the duodenum can take place, ultimately leading to fistula formation. We describe a case of MPD disruption following blunt abdominal trauma, complicated by a fistula between the pancreas and an open abdomen (pancreatico-atmospheric fistula). Although the fistula was managed using standard methods for treating pancreatic fistulas, wound care was a significant challenge in this case where the fistula exteriorized into an open abdomen.

Keywords


blunt abdominal trauma; pancreatico-cutaneous fistula; pancreatic injury; pancreatico-atmospheric fistula; distal pancreatectomy; wound care

Full Text:

PDF

References


Telford JJ, Farrell JJ, Saltzman JR, et al. Pancreatic stent placement for duct disruption. Gastrointest Endosc. 2002;56(1):18-24. doi: 10.1067/mge.2002.125107. PMID: 12085030.

Stawicki SP, Schwab CW. Pancreatic trauma: demographics, diagnosis, and management. Am Surg. 2008;74(12):1133-45. PMID: 19097525.

Chen Y, Jiang Y, Qian W, et al. Endoscopic transpapillary drainage in disconnected pancreatic duct syndrome after acute pancreatitis and trauma: long-term outcomes in 31 patients. BMC Gastroenterol. 2019;19(1):54. doi: 10.1186/s12876-019-0977-1. PMID: 30991953; PMCID: PMC6469079.

Ridgeway MG, Stabile BE. Surgical management and treatment of pancreatic fistulas. Surg Clin North Am. 1996;76(5):1159-73. doi: 10.1016/s0039-6109(05)70504-1. PMID: 8841370.

Simoneau E, Chughtai T, Razek T, Deckelbaum DL. Pancreaticoatmospheric fistula following severe acute necrotising pancreatitis. BMJ Case Rep. 2014;2014:bcr2014206131. doi: 10.1136/bcr-2014-206131. PMID: 25519860; PMCID: PMC4275764.

Cogbill TH, Moore EE, Morris JA Jr, et al. Distal pancreatectomy for trauma: a multicenter experience. J Trauma. 1991;31(12):1600-6. doi: 10.1097/00005373-199112000-00006. PMID: 1749029.

Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin North Am. 2007;87(6):1515-32, x. doi: 10.1016/j.suc.2007.08.007. PMID: 18053845.

Jurkovich GJ, Carrico CJ. Pancreatic trauma. Surg Clin North Am. 1990;70(3):575-93. doi: 10.1016/s0039-6109(16)45131-5. PMID: 2190335.

Baker RJ, Bass RT, Zajtchuk R, Strohl EL. External pancreatic fistula following abdominal injury. Arch Surg. 1967;95(4):556-66. doi: 10.1001/archsurg.1967.01330160026004. PMID: 5006627.

Huang CH, Kuyama T, Takeda J. Post-traumatic external pancreatic fistula. Am J Surg. 1967;113(6):816-8. doi: 10.1016/0002-9610(67)90353-4. PMID: 6023920.

Mayberry JC. Bedside open abdominal surgery. Utility and wound management. Crit Care Clin. 2000;16(1):151-72. doi: 10.1016/s0749-0704(05)70102-0. PMID: 10650505.

Rana SS, Sharma R, Gupta R. Endoscopic treatment of refractory external pancreatic fistulae with disconnected pancreatic duct syndrome. Pancreatology. 2019;19(4):608-613. doi: 10.1016/j.pan.2019.05.454. PMID: 31101469.

Tann M, Maglinte D, Howard TJ, et al. Disconnected pancreatic duct syndrome: imaging findings and therapeutic implications in 26 surgically corrected patients. J Comput Assist Tomogr. 2003;27(4):577-82. doi: 10.1097/00004728-200307000-00023. PMID: 12886147.

Varadarajulu S, Noone TC, Tutuian R, Hawes RH, Cotton PB. Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc. 2005;61(4):568-75. doi: 10.1016/s0016-5107(04)02832-9. PMID: 15812410.

Devière J, Bueso H, Baize M, Azar C, Love J, Moreno E, Cremer M. Complete disruption of the main pancreatic duct: endoscopic management. Gastrointest Endosc. 1995;42(5):445-51. doi: 10.1016/s0016-5107(95)70048-x. PMID: 8566636.

Pelaez-Luna M, Vege SS, Petersen BT, et al. Disconnected pancreatic duct syndrome in severe acute pancreatitis: clinical and imaging characteristics and outcomes in a cohort of 31 cases. Gastrointest Endosc. 2008;68(1):91-7. doi: 10.1016/j.gie.2007.11.041. PMID: 18378234.




DOI: http://dx.doi.org/10.22551/2023.41.1004.10270

Copyright (c) 2023 Shafic Abdulkarim, Saud Aldeghaither, Dan L Deckelbaum

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

 

ISSN: 2360-6975