Skip to main content
SpringerLink
Log in

The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury

  • Original Article
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Pancreatic trauma is associated with high mortality and morbidity, especially in main pancreatic duct (MPD) injuries. Here, we introduce a novel technique via the placement of bridge stenting-based internal drainage (BSID) along the injured MPD to restore pancreatic tissue integrity. Twelve patients with MPD injury underwent unobstructed BSID as physical support for healing. Six patients with peripheral organ injuries underwent operative end-to-end anastomosis of the MPD by using a polyurethane central venous catheter for the BSID, and the other six patients with isolated proximal MPD rupture received BSID via endoscopic pancreatic stent placement. The BSID technique was successfully performed in all pancreatic trauma patients without the need for a second open surgery. With this simplified BSID-based operation, a short procedure duration (242.7 ± 38.71 min in the surgical group and 100.2 ± 16.24 min in the endoscopic group) and a short hospital stay (13.0 ± 7.05 days) were achieved. However, a few complications (41.67%) still occurred, including pancreatitis, fistula, abscess, pseudocyst, cholangitis, and haemorrhage. Except for the deceased case, all postoperative courses were marked by decreases in the peripancreatic fluid collection, blood amylase recovery, and normal endocrine function. The BSID approach is a feasible surgical approach for the treatment of MPD injury and can be used endoscopically in isolated MPD injuries for its safety and convenience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Vasquez JC, Coimbra R, Hoyt DB, Fortlage D (2001) Management of penetrating pancreatic trauma: an 11-year experience of a level-1 trauma center. Injury 32(10):753–759. https://doi.org/10.1016/s0020-1383(01)00099-7

    Article  CAS  PubMed  Google Scholar 

  2. Stawicki SP, Schwab CW (2008) Pancreatic trauma: demographics, diagnosis, and management. Am Surgeon 74(12):1133–1145. https://doi.org/10.1111/j.1600-6143.2008.02441

    Article  PubMed  Google Scholar 

  3. Potoka DA, Gaines BA, Leppaniemi A, Peitzman AB (2015) Management of blunt pancreatic trauma: what’s new? Eur J Trauma Emerg Surg 41(3):239–250. https://doi.org/10.1007/s00068-015-0510-3

    Article  CAS  PubMed  Google Scholar 

  4. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, McAninch JW, Pachter HL, Shackford SR, Trafton PG (1990) Organ injury scaling, II: pancreas, duodenum, small bowel, colon, and rectum. J Trauma 30(11):1427–1429

    Article  CAS  PubMed  Google Scholar 

  5. Prachalias AA, Kontis E (2014) Isolated abdominal trauma: diagnosis and clinical management considerations. Curr Opin Crit Care 20(2):218–225. https://doi.org/10.1097/MCC.0000000000000074

    Article  PubMed  Google Scholar 

  6. Koh EY, van Poll D, Goslings JC, Busch OR, Rauws EA, Oomen MW, Besselink MG (2017) Operative versus nonoperative management of blunt pancreatic trauma in children: a systematic review. Pancreas 46(9):1091–1097. https://doi.org/10.1097/MPA.0000000000000916

    Article  PubMed  Google Scholar 

  7. Kim HS, Lee DK, Kim IW, Baik SK, Kwon SO, Park JW, Cho NC, Rhoe BS (2001) The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc 54(1):49–55. https://doi.org/10.1067/mge.2001.115733

    Article  CAS  PubMed  Google Scholar 

  8. Schellenberg M, Inaba K, Cheng V, Bardes JM, Lam L, Benjamin E, Matsushima K, Demetriades D (2018) Spleen-preserving distal pancreatectomy in trauma. J Trauma Acute Care Surg 84(1):118–122. https://doi.org/10.1097/TA.0000000000001725

    Article  PubMed  Google Scholar 

  9. Thakor AS, Sangha BS, Ho SG, Warnock GL, Meloche M, Liu DM (2015) Percutaneous autologous pancreatic islet cell transplantation for traumatic pancreatic injury. J Clin Endocrinol Metab 100(4):1230–1233. https://doi.org/10.1210/jc.2014-4165

    Article  CAS  PubMed  Google Scholar 

  10. Elmunzer BJ (2018) Endoscopic drainage of pancreatic fluid collections. Clin Gastroenterol Hepatol 16(12):1851–1863. https://doi.org/10.1016/j.cgh.2018.03.021

    Article  PubMed  Google Scholar 

  11. Thomas H, Madanur M, Bartlett A, Marangoni G, Heaton N, Rela M (2009) Pancreatic trauma–12-year experience from a tertiary center. Pancreas 38(2):113–116. https://doi.org/10.1097/MPA.0b013e31818d92d7

    Article  PubMed  Google Scholar 

  12. Fisher M, Brasel K (2011) Evolving management of pancreatic injury. Curr Opin Crit Care 17(6):613–617

    Article  PubMed  Google Scholar 

  13. Chinnery GE, Thomson SR, Ghimenton F, Anderson F (2008) Pancreatico-enterostomy for isolated main pancreatic duct disruption. Injury 39(1):50–56. https://doi.org/10.1097/MCC.0b013e32834cd374

    Article  PubMed  Google Scholar 

  14. Doley RP, Yadav TD, Kang M, Dalal A, Jayant M, Sharma R, Wig JD (2010) Traumatic transection of pancreas at the neck: feasibility of parenchymal preserving strategy. Gastroenterol Res 3(2):79–85. https://doi.org/10.4021/gr2010.02.163w

    Article  Google Scholar 

  15. Canty TG Sr, Weinman D (2001) Treatment of pancreatic duct disruption in children by an endoscopically placed stent. J Pediatr Surg 36(2):345–348. https://doi.org/10.1053/jpsu.2001.20712

    Article  PubMed  Google Scholar 

  16. Date S, Sato T (2015) Mini-gut organoids: reconstitution of the stem cell niche. J Annu Rev Cell Dev Biol 31:269–289. https://doi.org/10.1146/annurev-cellbio-100814-125218

    Article  CAS  Google Scholar 

  17. Kawahara I, Maeda K, Ono S, Kawashima H, Deie R, Yanagisawa S, Baba K, Usui Y, Tsuji Y, Fukuta A, Sekine S (2014) Surgical reconstruction and endoscopic pancreatic stent for traumatic pancreatic duct disruption. Pediatr Surg Int 30(9):951–956. https://doi.org/10.1007/s00383-014-3570-2

    Article  PubMed  Google Scholar 

  18. Menahem B, Lim C, Lahat E, Salloum C, Osseis M, Lacaze L, Compagnon P, Pascal G, Azoulay D (2016) Conservative and surgical management of pancreatic trauma in adult patients. Hepatobiliary Surg Nutr 5(6):470–477. https://doi.org/10.21037/hbsn.2016.07.01

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mansfield N, Inaba K, Berg R, Beale E, Benjamin E, Lam L, Matsushima K, Demetriades D (2017) Early pancreatic dysfunction after resection in trauma: an 18-year report from a Level I trauma center. J Trauma Acute Care Surg 82(3):528–533. https://doi.org/10.1097/TA.0000000000001327

    Article  PubMed  Google Scholar 

  20. Kong Y, Zhang H, He X, Liu C, Piao L, Zhao G, Zhen Y (2014) Endoscopic management for pancreatic injuries due to blunt abdominal trauma decreases failure of nonoperative management and incidence of pancreatic- related complications. Injury 45(1):134–140. https://doi.org/10.1016/j.injury.2013.07.017

    Article  PubMed  Google Scholar 

  21. Lillemoe KD, Kaushal S, Cameron JL, Sohn TA, Pitt HA, Yeo CJ (1999) Distal pancreatectomy: indications and outcomes in 235 patients. J Ann Surg 229(5):693–698. https://doi.org/10.1097/00000658-199905000-00012(discussion 698–700)

    Article  CAS  Google Scholar 

  22. Schellenberg M, Inaba K, Bardes JM, Cheng V, Matsushima K, Lam L, Benjamin E, Demetriades D (2018) Detection of traumatic pancreatic duct disruption in the modern era. Am J Surg 216(2):299–303. https://doi.org/10.1016/j.amjsurg.2018.06.002

    Article  PubMed  Google Scholar 

  23. Debi U, Kaur R, Prasad KK, Sinha SK, Sinha A, Singh K (2013) Pancreatic trauma: a concise review. World J Gastroenterol 19(47):9003–9011. https://doi.org/10.3748/wjg.v19.i47.9003

    Article  PubMed  PubMed Central  Google Scholar 

  24. Telford JJ, Farrell JJ, Saltzman JR, Shields SJ, Banks PA, Lichtenstein DR, Johannes RS, Kelsey PB, Carr-Locke DL (2002) Pancreatic stent placement for duct disruption. Gastrointest Endosc 56(1):18–24. https://doi.org/10.1067/mge.2002.125107

    Article  PubMed  Google Scholar 

  25. Liu DQ, Zhang H, Xiao L, Zhang BY, Liu WH (2019) Single-operator cholangioscopy for the treatment of concomitant gallbladder stones and secondary common bile duct stones. J Gastroenterol Hepatol 34(5):929–936. https://doi.org/10.1111/jgh.14468

    Article  PubMed  Google Scholar 

  26. Wolf A, Bernhardt J, Patrzyk M, Heidecke CD (2005) The value of endoscopic diagnosis and the treatment of pancreas injuries following blunt abdominal trauma. Surg Endosc 19(5):665–669. https://doi.org/10.1007/s00464-003-9276-5

    Article  CAS  PubMed  Google Scholar 

  27. Thomson DA, Krige JE, Thomson SR, Bornman PC (2014) The role of endoscopic retrograde pancreatography in pancreatic trauma: a critical appraisal of 48 patients treated at a tertiary institution. J Trauma Acute Care Surg 76(6):1362–1366. https://doi.org/10.1097/TA.0000000000000227

    Article  PubMed  Google Scholar 

  28. Bhasin DK, Rana SS, Rawal P (2009) Endoscopic retrograde pancreatography in pancreatic trauma: need to break the mental barrier. J Gastroenterol Hepatol 24(5):720–728. https://doi.org/10.1111/j.1440-1746.2009.05809.x

    Article  PubMed  Google Scholar 

  29. Dai R, Chen G, Huang Z, Yan H, Lin N, Yan Y, Wang T, Tang L (2012) Establishment and characteristics of an animal model for isolated pancreatic trauma. J Trauma Acute Care Surg 73(3):648–653. https://doi.org/10.1097/TA.0b013e318250ad07

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We sincerely thank the critical revisions by Professor Nalu Navarro-Alvarez from the College of Medicine, Harvard Medical School, and give thanks to Mr. Kai-jiong Li in beautifying the schematic diagrams for this manuscript. This work was partially supported by Foundation for National Clinic Key Construction Speciality (no. PTWK2016-CMGH), Natural Science Foundation of China (no. 81302168), and Scientific Foundation of Chengdu Medical College (no. CYZ19-07).

Author information

Author notes

  1. Xu-dong Wen and Dan-qing Liu contributed equally to this work.

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu, 610072, Sichuan Province, China

    Xu-dong Wen & Wei-hui Liu

  2. Department of Gastroenterology and Hepatology, Chengdu First People’s Hospital, Chengdu, 610016, Sichuan Province, China

    Xu-dong Wen

  3. General Surgery Center, The General Hospital of Western Theater Command, Chengdu, 610083, Sichuan Province, China

    Dan-qing Liu, Bing-yin Zhang, Le Xiao & Hong-tao Yan

Authors
  1. Xu-dong Wen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dan-qing Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bing-yin Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Le Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hong-tao Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wei-hui Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Hong-tao Yan or Wei-hui Liu.

Ethics declarations

Conflict of interest

The authors declare no competing interests.

Research involving human participants and/or animals

This study was performed in accordance with clinical study protocols and the principles of the Declaration of Helsinki (modified 2000) and was approved by the Research Care and Ethics Committee at our institution (No. SPPHCT2019–0901).

Informed consent

Written informed consent was obtained from all patients or their relatives.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wen, Xd., Liu, Dq., Zhang, By. et al. The bridge stenting-based internal drainage in pancreatic trauma patients with main pancreatic duct injury. Updates Surg 72, 717–726 (2020). https://doi.org/10.1007/s13304-020-00807-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-020-00807-5

Keywords

Search

Navigation