Xinlong Dai, Cheng Lu and Wentao Gao*
Department of Pancreas, The First Affiliated Hospital with Nanjing Medical University, ChinaFulltext PDF
Owing to the proximity of the pancreas and duodenum, the pathogenesis, diagnosis, and management of pancreaticoduodenal injury, while being distinct are all still interrelated. While management of pancreatic injury is related to injury classification, which may vary greatly from non-surgical intervention, operative therapy, or pancreaticoduodenectomy (PD), identification of pancreatic duct injury is the top priority. Although Magnetic Resonance Cholangiopancreatography (MRCP) and Endoscopic Retrograde Cholangiopancreatography (ERCP) are used as diagnostic modalities for pancreatic duct evaluation, sphincterotomy or stenting by ERCP for duct injury are still controversial. Non-surgical management is recommended for patients that do not have duct injuries. Once duct injury has occurred, appropriate debridement, resection, and reconstruction should be considered. Damage Control Surgery (DCS) is an option for critically ill patients concurrently with appropriate initial treatment and delayed reconstructive procedures. Decisionmaking of duodenal injury also depends on injury classification, and the consensus is primary repair with adequate drainage in case of perforation. Combined pancreaticoduodenal injury is associated with high morbidity and mortality. The effective prevention for pancreaticoduodenal injury-related complications are significant including delicate operation, precise hemostasis, thorough irrigation, and appropriate surgical options.
Pancreaticoduodenal injury; Diagnosis; Operative management; Magnetic resonance cholangiopancreatography; Endoscopic retrograde cholangiopancreatography
Dai X, Lu C, Gao W. Current Diagnosis and Management of Pancreaticoduodenal Injury: A Concise Review. Clin Oncol. 2017; 2: 1205.