Diagnostics and tactics of surgical treatment of patients with pancreatic trauma
I.S. MALKOV1, N.M. IGNATEVA2
1Kazan State Medical Academy, 36 Butlerov Str., Kazan, Russian Federation, 420012
2Municipal Clinical Hospital №7, 54 Chuikov Str., Kazan, Russian Federation, 420103
Malkov I.S. ― D. Med. Sc., Professor, Head of the Surgery Department, tel. +7-965-594-40-07, e-mail: Ismalkov@yahoo.com
Ignateva N.M. ― surgeon of the Surgery Department №2, tel. +7-905-313-25-05
The article analyzes the results of treating 13 patients with damage to the pancreas. The characteristics of the main clinical manifestations of pancreatic injury is given, it shows the complexity of the diagnosis of multisystem injuries. In doubtful cases the authors recommend the use of laparoscopy. Surgical treatment of patients with pancreatic trauma depended on the extent of injuries. So, when an injury was without damages to the capsule, and also had small subcapsular hematoma, was applied only drainage of an omental sac. In the presence of bleeding, vessel ligation or puncture of bleeding tissue was performed. With partial rupture of the pancreas, acufilopressure, drainage of an omental sac and an abdominal cavity were performed. With a complete rupture of the pancreas, its distal resection with splenectomy was performed, or in connection with critical condition of the victim, external drainage of the distal segment of the main pancreatic duct was applied. There were 5 deaths in the postoperative period. The mortality rate was 38.5%. The main causes of death in 3 victims were concomitant injury with severe traumatic and hypovolemic shock, in 2 cases ― post-traumatic pancreatitis and its complications (purulent-septic, arrosive bleeding).
Key words: pancreatic trauma, diagnosis, treatment strategy.