Role of Endoscopic Retrograde Pancreatography (ERP) in Diagnosis and Treatment of Pancreatic Trauma: Case Report
Abstract
Diagnosis of isolated pancreatic trauma is a clinical challenge because of its retroperitoneal location and no single diagnostic modality is highly specific and sensitive for pancreatic ductal injury. This article presented the benefit of endoscopic retrograde pancreatography (ERP) in diagnosis and therapeutic intervention in two patients who sustained blunt abdominal trauma and presented with equivocal clinical manifestation of pancreatic ductal injury.
Case 1: a 20 year-old man sustaining blunt abdominal trauma presented with minimal abdominal symptoms and signs whilst computer tomography (CT) showed features suggesting laceration of pancreatic head area. ERP revealed partial disruption of the main pancreatic duct and injected contrast media accumulated within pancreatic parenchymal tissue. The patient responded very well to conservative treatment and no complication detected during the two years of follow-up.
Case 2: a 45 year-old man developed severe abdominal pain which needed six hospitalizations within six months after negative abdominal exploration for blunt abdominal trauma. CT showed a 4x6cm size of pancreatic pseudocyst at the head of pancreas. ERP revealed complete disruption of main pancreatic duct. Endoscopic transpapillary drainage was successfully performed. He had no significant abdominal pain or other complication during four years of follow-up.
References
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2. Jurkovich GJ, Carrio CJ. Pancreatic trauma. Surg Clin N Am 1990;70(3): 575-93.
3. Heitsch RC, Knutson CO, Fulton RL, Jones CE. Surgery 1976; 80(4): 523-9.
4. Smego DR, Richardson JD, Flint LM. Determinants of outcome in pancreatic trauma. J Trauma 1985; 25:771-6.
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6. Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries: An analysis of management principles. Arch Surg 1990; 152: 1109-13.
7. Leppaniemi A, Haapianen R, Kiviluoto T, Lempinen M. Pancreatic trauma: acute and late manifestations. Br. J Surg 1998;75:165-7.
8. Cogbill TH, Moore EE, Kashuk JL. Changing trends in the management of pancreatic trauma. Arch Surg 1982; 117:772-82.
9. Ryan S, Sandler A, Trenhael S, Ephgrave K, Garner S. Pancreatic enzyme elevation after blunt trauma. J Trauma 1994;116:622-7.
10. Bouwman DC, Weaver DW, Walt AJ. S erum amylase and its isoenzyme: A clarification of their implication in trauma. J Trauma 1984;24:573-8.
11. Gomez GA, AIvarez R, Plaseneia G, Echeniqie M, Vopat JJ, Byers P, et al. Diagnostic peritoneal lavage in management of blunt abdominal trauma: A reassessment. J Trauma 1987;27:1-5.
12. Jeffery RB, Laing FC, Wing VW. Ultrasound in acute pancreatic trauma. Gastrointest Radiol 1986; 11: 44-6.
13. Cook DE, Walsh JW, Vick CW, Brewer WH. Upper abdominal trauma: Pitfalls in CT diagnosis. Radiology 1986; 159: 65-9.
14. Jeffery RB, Federle MP, Grass RA. Computed tomography of pancreatic trauma. Radiology 1983; 147: 491-4.
15. Gougeon FW, Legros G, Archambault A, Bessette G, Bastien EB. Pancreatic trauma: A new diagnostic approach. Am J Surg 1976;132: 400-2.
16. Jone RC. Management of pancreatic trauma. Am J Surg 1985:150:698-704.
17. Stone HH, Fabian TC, Satiani B, Turkleson ML. Experienes in the management of pancreatic trauma. J Trauma 1981;21:257-62.
18. Graham JH, Mattox KL, Jordan GL. Traumatic injuries of the pancreas. Am J Surg 1978; 136: 744-8.
19. Lucas CE. Diagnosis and treatment of pancreatic and duodenal injury. Surg Clin N Am 1977: 57: 49-65.
20. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling, II: pancreas, duodenum, small bowel, colon and rectum. J Trauma 1990:301: 1427-19.
21. Wong YC. Wang LJ, Lin BC, Chen CJ, Lim KE, Chen RJ, CT grading of blunt pancreatic injuries: Prediction of ductal disruption and surgical correlation. J Comput Assist Tomogr 1997:21:246-50.
22. Lane MJ, Mindelzun RE, Sandhu JS, McCormick VD, Jeffery RB. CT diagnosis of blunt pancreatic trauma: Importance of detecting fluid between the pancreas and the splenic vein. AJR 1994;163:833-5.
23. Dodds WJ, Taylor AJ, Erickson SJ, Lawson TL. Traumatic fracture of pancreas: CT characteristics. J Comput Assist Tomogr 1990; 14: 375-8.
24. Sivit CJ, Eichelberger MR, Taylor GA, Bulas DI, Gotschall CS, Kushner DC. Blunt pancreatic trauma in children: CT diagnosis. AJR 1992; 158: 1097-100.
25. Kim HS, Lee DK, Kim IW, Baik SK, Kwon SD, Park JW, et al. The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc 2001: 54: 49-55.
26. Berni GA, Badyk DF, Oreskovich MR, Carrio CJ. Role of intraoperative pancreatography in patients with injury to pancreas. Am J Surg 1982; 143: 602-5.
27. Taxier M, Sivak MV, Cooperman VM, Sullivan BH. Endoscopic retrograde pancreatography on the evaluation of trauma to the pancreas. Surg Gynecol Obstet. 1980; 105: 65-8.
28. Laraja RD, Lobbato BJ, Cassaro S, Reddy SS. Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) in penetrating trauma of pancreas. J Trauma 1986; 26:1146-7.
29. Barkin JS. Ferstenberg RM, Panullo W, Manten HD, Davis RC. Endoscopic retrograde cholangiopancreatography in pancreatic trauma. Gastrointest Endosc 1988: 34: 102-5.
30. Hayward SR, Lucas CE, Sugawa C, Ledgerwood AM. Emergent endoscopic retrograde cholangiopancreatography. Arch Surg 1989; 124: 745-6.
31. Stone A, Sugawa C, Lucas C, Hayward S, Nakamura R. The role of endoscopic retrograde pancreatography (ERP) in blunt abdominal trauma. Am Surg 1990: 56: 715-20.
32. Doctor N, Dooley JS, Davidson BR. Assessment of pancreatic duct damage following trauma: Is endoscopic retrograde cholangiopancreatography the gold standard? Postgrad Med J 1995;71: 116-7.
33. Harrell DJ, Vitale GC, Larson GM. Selective role for endoscopic retrograde cholangiopancreatography in abdominal trauma. Surg Endosc 1998: 12: 400-4.
34. Hall RI, Lavelle MI, Venables CW. Use of ERCP to identify the site Of traumatic injuries of the main pancreatic duct in children. Br J Surg 1986; 73: 411-2.
35. Rescorla FJ, Plumley DA, Sherman S, Scherer LR, West KW, Grosfeld JL. The efficacy of early ERCP in pediatric pancreatic trauma. J Pediatr Surg 1995; 30: 336-40.
36. Fabre JH, Bauret P, Prudhomme M, Quenet F, Noelp, Baumel H, et al. Posttraumatic pancreatic fistula cured by endoprosthesis in pancreatic duct. Am J Gastroenterol 1995;90:804-6.
37. Huckfeldt R, Agee C, Nichol K, Barthet J. Nonoperative treatment of traumatic pancreatic duct disruption using an endoscopically placed stent. J Trauma 1996; 41: 143-4.
38. Amirata E, Livingston DH, Elcavage J. Octreotide acetate decreases pancreatic complication after pancreatic trauma. Am J Surg 1994; 168: 345-7.
39. Buchler M, Friss H, Klempa l, Hermanek P, Sulkowski V, Becker H, et al. Role of octreotide in prevention of postoperative complication following pancreatic resection. Am J Surg 1992; 163:125-31.
40. Yeo CJ, Bastidas A, Lynch -Nyhan A, Fishman EK, Zinner MJ. Cameron JL. Natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 1990; 170: 411-7.
41. Deviere J, Bueso H, Baize M, Azar C, Love J, Moreno E, et al. Complete disruption of the main pancreatic duct: Endoscopic management. Gastrointest Endosc 1995; 5: 445-51.
42. Binmoeller K, Seifert H, Walter A, Sohendra N. Transpapillary and transmural drainage of pancreatic pseudocyst. Gastrointest Endosc 1995; 42: 219-24.
43. Siegel J, Veeappan A. Endoscopic management of pancreatic disorder: Potential risks of pancreatic prosthesis. Endoscopy 1991; 23: 177-80.
44. Huibregste K, Smits ME. Endoscopic management of disease of the pancreas. Am J Gastroenterol 1994; 89: 566-77.
2. Jurkovich GJ, Carrio CJ. Pancreatic trauma. Surg Clin N Am 1990;70(3): 575-93.
3. Heitsch RC, Knutson CO, Fulton RL, Jones CE. Surgery 1976; 80(4): 523-9.
4. Smego DR, Richardson JD, Flint LM. Determinants of outcome in pancreatic trauma. J Trauma 1985; 25:771-6.
5. Wilson RH, Moorehead RJ. Current management of trauma to pancreas. Br J Surg 1991; 78:1196-202.
6. Wisner DH, Wold RL, Frey CF. Diagnosis and treatment of pancreatic injuries: An analysis of management principles. Arch Surg 1990; 152: 1109-13.
7. Leppaniemi A, Haapianen R, Kiviluoto T, Lempinen M. Pancreatic trauma: acute and late manifestations. Br. J Surg 1998;75:165-7.
8. Cogbill TH, Moore EE, Kashuk JL. Changing trends in the management of pancreatic trauma. Arch Surg 1982; 117:772-82.
9. Ryan S, Sandler A, Trenhael S, Ephgrave K, Garner S. Pancreatic enzyme elevation after blunt trauma. J Trauma 1994;116:622-7.
10. Bouwman DC, Weaver DW, Walt AJ. S erum amylase and its isoenzyme: A clarification of their implication in trauma. J Trauma 1984;24:573-8.
11. Gomez GA, AIvarez R, Plaseneia G, Echeniqie M, Vopat JJ, Byers P, et al. Diagnostic peritoneal lavage in management of blunt abdominal trauma: A reassessment. J Trauma 1987;27:1-5.
12. Jeffery RB, Laing FC, Wing VW. Ultrasound in acute pancreatic trauma. Gastrointest Radiol 1986; 11: 44-6.
13. Cook DE, Walsh JW, Vick CW, Brewer WH. Upper abdominal trauma: Pitfalls in CT diagnosis. Radiology 1986; 159: 65-9.
14. Jeffery RB, Federle MP, Grass RA. Computed tomography of pancreatic trauma. Radiology 1983; 147: 491-4.
15. Gougeon FW, Legros G, Archambault A, Bessette G, Bastien EB. Pancreatic trauma: A new diagnostic approach. Am J Surg 1976;132: 400-2.
16. Jone RC. Management of pancreatic trauma. Am J Surg 1985:150:698-704.
17. Stone HH, Fabian TC, Satiani B, Turkleson ML. Experienes in the management of pancreatic trauma. J Trauma 1981;21:257-62.
18. Graham JH, Mattox KL, Jordan GL. Traumatic injuries of the pancreas. Am J Surg 1978; 136: 744-8.
19. Lucas CE. Diagnosis and treatment of pancreatic and duodenal injury. Surg Clin N Am 1977: 57: 49-65.
20. Moore EE, Cogbill TH, Malangoni MA, Jurkovich GJ, Champion HR, Gennarelli TA, et al. Organ injury scaling, II: pancreas, duodenum, small bowel, colon and rectum. J Trauma 1990:301: 1427-19.
21. Wong YC. Wang LJ, Lin BC, Chen CJ, Lim KE, Chen RJ, CT grading of blunt pancreatic injuries: Prediction of ductal disruption and surgical correlation. J Comput Assist Tomogr 1997:21:246-50.
22. Lane MJ, Mindelzun RE, Sandhu JS, McCormick VD, Jeffery RB. CT diagnosis of blunt pancreatic trauma: Importance of detecting fluid between the pancreas and the splenic vein. AJR 1994;163:833-5.
23. Dodds WJ, Taylor AJ, Erickson SJ, Lawson TL. Traumatic fracture of pancreas: CT characteristics. J Comput Assist Tomogr 1990; 14: 375-8.
24. Sivit CJ, Eichelberger MR, Taylor GA, Bulas DI, Gotschall CS, Kushner DC. Blunt pancreatic trauma in children: CT diagnosis. AJR 1992; 158: 1097-100.
25. Kim HS, Lee DK, Kim IW, Baik SK, Kwon SD, Park JW, et al. The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury. Gastrointest Endosc 2001: 54: 49-55.
26. Berni GA, Badyk DF, Oreskovich MR, Carrio CJ. Role of intraoperative pancreatography in patients with injury to pancreas. Am J Surg 1982; 143: 602-5.
27. Taxier M, Sivak MV, Cooperman VM, Sullivan BH. Endoscopic retrograde pancreatography on the evaluation of trauma to the pancreas. Surg Gynecol Obstet. 1980; 105: 65-8.
28. Laraja RD, Lobbato BJ, Cassaro S, Reddy SS. Intraoperative endoscopic retrograde cholangiopancreatography (ERCP) in penetrating trauma of pancreas. J Trauma 1986; 26:1146-7.
29. Barkin JS. Ferstenberg RM, Panullo W, Manten HD, Davis RC. Endoscopic retrograde cholangiopancreatography in pancreatic trauma. Gastrointest Endosc 1988: 34: 102-5.
30. Hayward SR, Lucas CE, Sugawa C, Ledgerwood AM. Emergent endoscopic retrograde cholangiopancreatography. Arch Surg 1989; 124: 745-6.
31. Stone A, Sugawa C, Lucas C, Hayward S, Nakamura R. The role of endoscopic retrograde pancreatography (ERP) in blunt abdominal trauma. Am Surg 1990: 56: 715-20.
32. Doctor N, Dooley JS, Davidson BR. Assessment of pancreatic duct damage following trauma: Is endoscopic retrograde cholangiopancreatography the gold standard? Postgrad Med J 1995;71: 116-7.
33. Harrell DJ, Vitale GC, Larson GM. Selective role for endoscopic retrograde cholangiopancreatography in abdominal trauma. Surg Endosc 1998: 12: 400-4.
34. Hall RI, Lavelle MI, Venables CW. Use of ERCP to identify the site Of traumatic injuries of the main pancreatic duct in children. Br J Surg 1986; 73: 411-2.
35. Rescorla FJ, Plumley DA, Sherman S, Scherer LR, West KW, Grosfeld JL. The efficacy of early ERCP in pediatric pancreatic trauma. J Pediatr Surg 1995; 30: 336-40.
36. Fabre JH, Bauret P, Prudhomme M, Quenet F, Noelp, Baumel H, et al. Posttraumatic pancreatic fistula cured by endoprosthesis in pancreatic duct. Am J Gastroenterol 1995;90:804-6.
37. Huckfeldt R, Agee C, Nichol K, Barthet J. Nonoperative treatment of traumatic pancreatic duct disruption using an endoscopically placed stent. J Trauma 1996; 41: 143-4.
38. Amirata E, Livingston DH, Elcavage J. Octreotide acetate decreases pancreatic complication after pancreatic trauma. Am J Surg 1994; 168: 345-7.
39. Buchler M, Friss H, Klempa l, Hermanek P, Sulkowski V, Becker H, et al. Role of octreotide in prevention of postoperative complication following pancreatic resection. Am J Surg 1992; 163:125-31.
40. Yeo CJ, Bastidas A, Lynch -Nyhan A, Fishman EK, Zinner MJ. Cameron JL. Natural history of pancreatic pseudocysts documented by computed tomography. Surg Gynecol Obstet 1990; 170: 411-7.
41. Deviere J, Bueso H, Baize M, Azar C, Love J, Moreno E, et al. Complete disruption of the main pancreatic duct: Endoscopic management. Gastrointest Endosc 1995; 5: 445-51.
42. Binmoeller K, Seifert H, Walter A, Sohendra N. Transpapillary and transmural drainage of pancreatic pseudocyst. Gastrointest Endosc 1995; 42: 219-24.
43. Siegel J, Veeappan A. Endoscopic management of pancreatic disorder: Potential risks of pancreatic prosthesis. Endoscopy 1991; 23: 177-80.
44. Huibregste K, Smits ME. Endoscopic management of disease of the pancreas. Am J Gastroenterol 1994; 89: 566-77.
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Published
2002-12-27
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Treesaranuwattana S, Pantukosit S, Matrakool L, Khemtai C. Role of Endoscopic Retrograde Pancreatography (ERP) in Diagnosis and Treatment of Pancreatic Trauma: Case Report. Thai J Surg [Internet]. 2002 Dec. 27 [cited 2024 Dec. 23];23(4):119-24. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/243040
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