Conservative management in a case of pancreatic trauma with Wirsung duct injury
DOI:
https://doi.org/10.47456/rbps.v25isupl_1.41043Keywords:
Conservative treatment, Abdominal injuries, Pancreatic ductsAbstract
Introduction:
The diagnosis of pancreatic injuries can be challenging. Although the FAST is efficient in detecting hemoperitoneum, one third of patients with pancreatic injury have normal FAST. Thus, the diagnosis is made by computed tomography (CT) or laparotomy. Complications of pancreatic injury occur in up to 50% of cases and include fistula, pseudocyst and abdominal abscesses. Appropriate management is essential in the outcome of morbidity and mortality. Case report: A 21-year-old male patient was admitted to the HEUE with a history of blunt abdominal trauma. CT showed hemoperitoneum and laceration of the pancreas head involving the Wirsung duct. At laparotomy, there wasn’t success in visualizing pancreatic lesions. He was referred to the HUCAM with a septic condition and antibiotic therapy, TPN and liquid diet were started. After 10 days ERCP showed stenosis of distal common bile duct, papillotomy was performed with placement of a biliary prosthesis, without success in accessing the pancreatic pathway. With impossibility of catheterizing the Wirsung duct via ERCP, a surgical approach was indicated, which showed firm adhesions in the upper abdomen, in addition to candle drippings in the omentum. In this scenario, tactical cholecystectomy and splenectomy for catheterization of the duct via the tail of the pancreas was performed. He was discharged with a Wirsung catheter and evolved with a pancreatic pseudocyst, which required transgastric drainage. Subsequently, the catheter was removed with no output, and CT showed resolution of the pseudocyst. Evolved without complaints. He is still being followed up at the HUCAM GIS outpatient clinic. Conclusion: The case in question shows the successful use of an exception tactic in the treatment of pancreatic trauma with involvement of the Wirsung duct. The conservative approach spared a large part of the pancreatic parenchyma that would be lost with an initial surgical approach, and the patient evolved favorably.
Downloads
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Brazilian Journal of Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The Revista Brasileira de Pesquisa em Saúde (RBPS) adopts the CC BY 4.0 license, which means that authors retain the copyright of the works they submit to the journal. Authors are responsible for declaring that their contribution is an original manuscript, that it has not been previously published, and that it is not under simultaneous review by another scientific journal. Upon submitting the manuscript, authors grant RBPS the exclusive right of first publication, subject to peer review.
Authors are permitted to enter into additional contracts for the non-exclusive distribution of the version published by RBPS (for example, in institutional repositories or as a book chapter), provided that due acknowledgment of authorship and of initial publication by RBPS is given. Authors are also encouraged to make their work available online (for example, in institutional repositories or on their personal pages) after its initial publication in the journal, with due acknowledgment of authorship and of the original publication by RBPS.
Accordingly, under the CC BY 4.0 license, readers have the right to:
- Share — copy and redistribute the material in any medium or format for any purpose, even commercially;
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
