Experience of surgical treatment of combat pancreatic trauma
Background. Pancreatic injuries is a complex challenge for trauma surgeons, especially if combat, due to the presence of combined injuries and complications. The aim: to provide a structure, peculiarities of diagnosis and treatment of combat pancreatic trauma. Materials and methods. A retrospective...
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Zaslavsky O.Yu.
2024-12-01
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| Series: | Медицина неотложных состояний |
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| Online Access: | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1808 |
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| author | Е.М. Хорошун І.П. Хоменко С.А. Шипілов В.В. Макаров В.В. Негодуйко О.Г. Петюнін |
| author_facet | Е.М. Хорошун І.П. Хоменко С.А. Шипілов В.В. Макаров В.В. Негодуйко О.Г. Петюнін |
| author_sort | Е.М. Хорошун |
| collection | DOAJ |
| description | Background. Pancreatic injuries is a complex challenge for trauma surgeons, especially if combat, due to the presence of combined injuries and complications. The aim: to provide a structure, peculiarities of diagnosis and treatment of combat pancreatic trauma. Materials and methods. A retrospective analysis was done of medical records of 58 inpatients who sustained combat pancreatic trauma during the war in Ukraine. Their average age was 37.4 ± 3.6 years (range 21–60 years). The mechanism of combat injury included gunshot wounds (87.9 %), explosive (10.3 %) and closed injuries (1.7 %). All the wounded underwent laboratory and instrumental investigations. Results. According to the nature of the combat injury, pancreatic injuries were categorised into gunshot shrapnel wounds — 50 (86.2 %), gunshot bullet wounds — 1 (1.7 %), explosive trauma — 6 (10.3 %), and closed combat trauma — 1 (1.7 %) case. Distribution by location of pancreatic injury: tail — 38 (65.5 %), head — 11 (19 %), body — 5 (8.6 %), body and tail — 2 (3.4 %), head and tail — 2 (3.4 %) cases. The following methods of surgical intervention were used: damage control surgery (DCS) — 51 (87.9 %) cases, one-stage surgery — 7 (12.1 %) cases. Distribution by the type of surgical intervention for pancreatic injury: drainage of the parapancreatic space — 45 (77.6 %), pancreatorrhaphy — 4 (6.9 %), distal pancreatosplenectomy — 3 (5.2 %), removal of foreign bodies (metal fragments) — 3 (5.2 %), distal resection of the pancreas with spleen preservation — 1 (1.7 %), pancreatoduodenectomy — 1 (1.7 %), subtotal resection of the body and tail of the pancreas with splenectomy — 1 (1.7 %) case. Common complications (n = 42): peritonitis — 9 (21.4 %), acute surgical sepsis — 8 (19 %), acute renal failure — 7 (16.7 %), multiple organ failure syndrome — 7 (16.7 %), pneumonia — 6 (14.3 %), bleeding — 4 (9.5 %), pulmonary embolism — 1 (2.4 %). Organ-specific complications (n = 28) were as follows: acute pancreatitis — 21 (75 %), pancreatic fistula — 4 (14.3 %), pseudocysts — 2 (7.1 %), abscess — 1 (3.6 %) case. Treatment outcomes: 33 patients (56.9 %) were transferred to the next stage of treatment, 19 (32.8 %) died, and 6 (10.3 %) were discharged with a definite outcome. Mortality rate: 5 (26.3 %) died in the first 3 days, 14 (73.7 %) cases died in the period from 4 to 15 days. Conclusions. The incidence of combat pancreatic trauma among abdominal wounds is 8.7 %. Surgical treatment for combat pancreatic trauma using the DCS is performed in 87.9 % of cases, and in the volume of a single-stage operation, in 12.1 %. The DCS leads to a reduction in the incidence of complications. The overall complication rate for combat pancreatic trauma is 72.4 %, and the incidence of organ-specific complications is 48.3 %. Mortality from pancreatic injuries is 32.8 %. Combat trauma to the head of the pancreas was mainly treated with closed drainage. Distal injuries were treated by resection or drainage. |
| format | Article |
| id | doaj-art-400a88416bd54b5e9a3cc321d34b31e4 |
| institution | DOAJ |
| issn | 2224-0586 2307-1230 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Zaslavsky O.Yu. |
| record_format | Article |
| series | Медицина неотложных состояний |
| spelling | doaj-art-400a88416bd54b5e9a3cc321d34b31e42025-08-20T02:48:10ZengZaslavsky O.Yu.Медицина неотложных состояний2224-05862307-12302024-12-0120872572910.22141/2224-0586.20.8.2024.18081808Experience of surgical treatment of combat pancreatic traumaЕ.М. Хорошун0https://orcid.org/0000-0003-1258-1319І.П. Хоменко1https://orcid.org/0000-0002-8199-5083С.А. Шипілов2https://orcid.org/0000-0002-1689-2213В.В. Макаров3https://orcid.org/0000-0002-4224-0294В.В. Негодуйко4https://orcid.org/0000-0003-4540-5207О.Г. Петюнін5https://orcid.org/0000-0001-9411-994XKharkiv National Medical University, Kharkiv, Ukraine; Military Medical Clinical Center of the Northern Region, Kharkiv, UkraineNational Academy of Medical Sciences of Ukraine, Kyiv, Ukraine; Kyiv City Clinical Hospital 8, Kyiv, UkraineKharkiv National Medical University, Kharkiv, Ukraine; Military Medical Clinical Center of the Northern Region, Kharkiv, UkraineKharkiv National Medical University, Kharkiv, Ukraine; Military Medical Clinical Center of the Northern Region, Kharkiv, UkraineKharkiv National Medical University, Kharkiv, Ukraine; Military Medical Clinical Center of the Northern Region, Kharkiv, UkraineKharkiv National Medical University, Kharkiv, Ukraine; Kharkiv Institute of Medicine and Biomedical Sciences, Kharkiv, UkraineBackground. Pancreatic injuries is a complex challenge for trauma surgeons, especially if combat, due to the presence of combined injuries and complications. The aim: to provide a structure, peculiarities of diagnosis and treatment of combat pancreatic trauma. Materials and methods. A retrospective analysis was done of medical records of 58 inpatients who sustained combat pancreatic trauma during the war in Ukraine. Their average age was 37.4 ± 3.6 years (range 21–60 years). The mechanism of combat injury included gunshot wounds (87.9 %), explosive (10.3 %) and closed injuries (1.7 %). All the wounded underwent laboratory and instrumental investigations. Results. According to the nature of the combat injury, pancreatic injuries were categorised into gunshot shrapnel wounds — 50 (86.2 %), gunshot bullet wounds — 1 (1.7 %), explosive trauma — 6 (10.3 %), and closed combat trauma — 1 (1.7 %) case. Distribution by location of pancreatic injury: tail — 38 (65.5 %), head — 11 (19 %), body — 5 (8.6 %), body and tail — 2 (3.4 %), head and tail — 2 (3.4 %) cases. The following methods of surgical intervention were used: damage control surgery (DCS) — 51 (87.9 %) cases, one-stage surgery — 7 (12.1 %) cases. Distribution by the type of surgical intervention for pancreatic injury: drainage of the parapancreatic space — 45 (77.6 %), pancreatorrhaphy — 4 (6.9 %), distal pancreatosplenectomy — 3 (5.2 %), removal of foreign bodies (metal fragments) — 3 (5.2 %), distal resection of the pancreas with spleen preservation — 1 (1.7 %), pancreatoduodenectomy — 1 (1.7 %), subtotal resection of the body and tail of the pancreas with splenectomy — 1 (1.7 %) case. Common complications (n = 42): peritonitis — 9 (21.4 %), acute surgical sepsis — 8 (19 %), acute renal failure — 7 (16.7 %), multiple organ failure syndrome — 7 (16.7 %), pneumonia — 6 (14.3 %), bleeding — 4 (9.5 %), pulmonary embolism — 1 (2.4 %). Organ-specific complications (n = 28) were as follows: acute pancreatitis — 21 (75 %), pancreatic fistula — 4 (14.3 %), pseudocysts — 2 (7.1 %), abscess — 1 (3.6 %) case. Treatment outcomes: 33 patients (56.9 %) were transferred to the next stage of treatment, 19 (32.8 %) died, and 6 (10.3 %) were discharged with a definite outcome. Mortality rate: 5 (26.3 %) died in the first 3 days, 14 (73.7 %) cases died in the period from 4 to 15 days. Conclusions. The incidence of combat pancreatic trauma among abdominal wounds is 8.7 %. Surgical treatment for combat pancreatic trauma using the DCS is performed in 87.9 % of cases, and in the volume of a single-stage operation, in 12.1 %. The DCS leads to a reduction in the incidence of complications. The overall complication rate for combat pancreatic trauma is 72.4 %, and the incidence of organ-specific complications is 48.3 %. Mortality from pancreatic injuries is 32.8 %. Combat trauma to the head of the pancreas was mainly treated with closed drainage. Distal injuries were treated by resection or drainage.https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1808pancreatic injurygunshot woundscombat traumasurgical treatment |
| spellingShingle | Е.М. Хорошун І.П. Хоменко С.А. Шипілов В.В. Макаров В.В. Негодуйко О.Г. Петюнін Experience of surgical treatment of combat pancreatic trauma Медицина неотложных состояний pancreatic injury gunshot wounds combat trauma surgical treatment |
| title | Experience of surgical treatment of combat pancreatic trauma |
| title_full | Experience of surgical treatment of combat pancreatic trauma |
| title_fullStr | Experience of surgical treatment of combat pancreatic trauma |
| title_full_unstemmed | Experience of surgical treatment of combat pancreatic trauma |
| title_short | Experience of surgical treatment of combat pancreatic trauma |
| title_sort | experience of surgical treatment of combat pancreatic trauma |
| topic | pancreatic injury gunshot wounds combat trauma surgical treatment |
| url | https://emergency.zaslavsky.com.ua/index.php/journal/article/view/1808 |
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