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An analysis of predictors of morbidity after stab wounds of the pancreas in 78
consecutive injuries
#MMPMID25198973
Krige JE
; Kotze UK
; Sayed R
; Navsaria PH
; Nicol AJ
Ann R Coll Surg Engl
2014[Sep]; 96
(6
): 427-33
PMID25198973
show ga
INTRODUCTION: Penetrating injuries of the pancreas may result in serious
complications. This study assessed the factors influencing morbidity after stab
wounds of the pancreas. METHODS: A retrospective univariate cohort analysis was
carried out of 78 patients (74 men) with a median age of 26 years (range: 16-62
years) with stab wounds of the pancreas between 1982 and 2011. RESULTS: The
median revised trauma score (RTS) was 7.8 (range: 2.0-7.8). Injuries involved the
body (n=36), tail (n=24), head/uncinate process (n=16) and neck (n=2) of the
pancreas. All 78 patients underwent a laparotomy. Sixty-five patients had AAST
(American Association for the Surgery of Trauma) grade I or II pancreatic
injuries and thirteen had grade III, IV or V injuries. Eight patients (10.3%) had
an initial damage control operation. Sixty-nine patients (84.6%) had drainage of
the pancreas only, six had a distal pancreatectomy and one had a
pancreaticoduodenectomy. Most pancreas related complications occurred in patients
with AAST grade III injuries; eight patients (10.2%) developed a pancreatic
fistula. Four patients (5.1%) died. Grade of pancreatic injury (AAST grade I-II
vs grade III-V injuries, p<0.001), RTS (odds ratio [OR]: 5.01, 95% confidence
interval [CI]: 1.46-17.19, p<0.007), presence of shock on admission (OR: 3.31,
95% CI: 1.16-9.42, p=0.022), need for a blood transfusion (OR: 6.46, 95% CI:
2.40-17.40, p<0.001) and repeat laparotomy (p<0.001) had a significant influence
on the development of general complications. CONCLUSIONS: Although mortality was
low after a pancreatic stab wound, morbidity was high. Increasing AAST grade of
injury, high RTS, shock on admission to hospital, need for blood transfusion and
repeat laparotomy were significant factors related to morbidity.
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