Conservation du pancréas gauche dans les ruptures de l'isthme pancréatique. Á propos de trois cas

Abstract

Aim of the study

To report three cases of neck pancreatic disruption caused by blunt abdominal trauma and to emphasize the advantages of conservative surgery with internal drainage.

Patients and results

In two cases, one with hemoperitoneum, and the other with intraperitoneal fluid collection with 1,323 U/mL of amylase, laparotomy showed a complete disruption of the neck of the pancreas. The pancreatic head side was sutured whereas the left side was anastomosed to a Roux-en-Y jejunal loop. The clinical results were good at 8 and 6 months after surgery, respectively. For the third patient, a pancreatic trauma (which was suspected on a CT. Scan), was not confirmed at laparotomy. In the postoperative course, the amount of fluid drainage was important and the endoscopic retrograde pancreatography (ERCP) showed a disruption of the neck of the pancreas. An endoprosthesis was placed into the duct of Wirsung. Three months later, the patient complained of pain, and a migration of the prosthesis was detected by X-ray examination. It was not possible to place another endoprosthesis because of a stenosis of the duct. A resection of the neck of the pancreas was performed, the cephalic side was sutured and the left side anastomosed to the posterior gastric wall. Eight months after surgery, the clinical result was good and glycemia was normal.

Conclusion

In blunt abdominal trauma, if a pancreas injury is suspected upon clinical presentation an ERCP, or moreover a magnetic resonance imaging, is indicated. When there is no disruption of the Wirsung duct, a simple péritonéal drainage should suffice. In cases with partial disruption, an endoprosthesis may give good results. In patients with a complete disruption, as in the three cases reported, a suture of the head side of the pancreas, and an internal drainage of the left side with a Roux-en-Y jejunal loop (or more easily with the stomach), are indicated.