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31 May 2024 (Vol 47 , Iss 05 )

Journal ID : TMJ-26-09-2021-10667
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Title : An optimized management outcome of a challenging late intervention of pancreatic neck transection; a case report and mini-review

Abstract :

The high-grade pancreatic injury including pancreatic transection is a challenging issue in management carrying high morbidity and mortality because of the associated injuries and pancreas-specific morbidity. The late surgical intervention till a week after the accident would be highly challenging carrying a higher probability of morbidity and mortality. There is no consensus on which management strategies result in the most favorable outcomes. Herein, we will present this case report of pancreatic transection with late intervention who had an optimized approach of management to reach the best outcome. Pancreatic fracture in a 23-year-old car crash victim who had a late surgical intervention after one week of the accident. The patient had been optimized in a well-balanced approach of diagnosis and treatment till he passed with no residual complication till 2-year follow- up. The updated guidelines in conjunction with the teamwork helped us in the clinical management of this case report, and although they weren't used to replace clinical judgment, they were extremely useful for decision-making. There are higher attributable morbidity and mortality rates for injuries involving the pancreatic duct, as well as the potential for deterioration if treatment is delayed, and literature supports resection in these cases. Repetition of CT or its combination with Cholangiopancreatography (endoscopic or magnetic resonance) may be needed to make a diagnosis of ductal injury. The use of ERCP is also recommended for the purpose of diagnostic confirmation, biliary and pancreatic drainage and stenting, and intraoperative guide for pancreatic duct identification and control. The enteral access is very beneficial for the patient support in such cases.

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