Spontaneous Healing After Conservative Treatment Of Isolated Grade Iv Pancreatic Duct Disruption Caused By Trauma: A Case Report
Mei, M. Z., Ren, Y. F., Mou, Y. P., Wang, Y. Y., Jin, W. W., Lu, C., & Zhu, Q. C. (2022). Spontaneous healing after conservative treatment of isolated grade IV pancreatic duct disruption caused by trauma: A case report. World journal of clinical cases, 10(18), 6319–6324. https://doi.org/10.12998/wjcc.v10.i18.6319
View Original Source →Abstract
BACKGROUND: Trauma is a common cause of pancreatic duct disruption. Surgical treatment is recommended in current clinical guidelines for adult pancreatic injury because non-surgical treatments have higher risks of serious complications or even death compared with surgical treatment. CASE SUMMARY: A 22-year-old woman was admitted to Tiantai People's Hospital of Zhejiang Province after 1-h duration of abdominal pain and distension following trauma. The diagnosis was "traumatic pancreatic rupture". The patient's symptoms were not severe, her vital signs were stable, and signs of peritonitis were not obvious. Therefore, conservative treatment could be considered, with the possibility of emergency surgery if necessary. After 2 mo of conservative treatment with duct drainage, the pancreatic duct healed spontaneously with no significant complications. CONCLUSION: We report a case of pancreatic duct disruption in the head and neck caused by trauma that was treated conservatively and healed spontaneously, providing a new choice for clinical practice. For isolated pancreatic injury with rupture of the pancreatic duct in the head and neck, conservative treatment under close observation is feasible.
Case Details
Disease Location
Pancreas
Personal Characteristics
22-year-old female patient
Clinical Characteristics
Admitted after 1-hour duration of abdominal pain and distension following trauma. Laboratory examination revealed: elevated serum amylase concentration, leukocytosis. Abdominal CT demonstrated that the pancreatic head/neck was full in shape, and small lamellar high-density shadows were seen at the anterior edge. The diagnosis was “traumatic pancreatic rupture”. The patient was then treated with fasting, gastrointestinal decompression, acid control, digestive enzyme inhibition, anti-inflammation, and fluid replacement. 1 week later, a naso-intestinal tube was placed for enteral feeding. 10 days after admission, an ultrasound showed a local fluid collection in the neck of the pancreas measuring approximately 60 mm × 46 mm × 38 mm. Therefore, catheter drainage of the peripancreatic fluid collection was performed.
Remission Characteristics
2 months later an endoscopic retrograde cholangiopancreatography (ercp) was performed to place a pancreatic duct stent. The pancreatic duct in the pancreatic head was circular in shape and was not connected with the pancreatic duct in the pancreatic body/tail. Therefore, the pancreatic duct stent could not be placed. After 2 months of conservative treatment with duct drainage, the pancreatic duct healed spontaneously with no significant complications.
Treatment & Mechanisms
Clinical Treatment
Gastrointestinal decompression, acid control, digestive enzyme inhibition, anti-inflammation, and fluid replacement, naso-intestinal tube, catheter drainage
Non-Clinical Treatment
Fasting