Published online May 16, 2022. doi: 10.4253/wjge.v14.i5.342
Peer-review started: January 15, 2022
First decision: March 8, 2022
Revised: March 9, 2022
Accepted: April 15, 2022
Article in press: April 15, 2022
Published online: May 16, 2022
Processing time: 120 Days and 14.7 Hours
In order to successfully manage traumatic pancreatic duct (PD) leaks, early diagnosis and operative management is paramount in reducing morbidity and mortality. In the acute setting, endoscopic retrograde cholangiopancreatography (ERCP) can be a useful, adjunctive modality during exploratory laparotomy. ERCP with sphincterotomy and stent placement improves preferential drainage in the setting of injury, allowing the pancreatic leak to properly heal. However, data in this acute setting is limited.
In this case series, a 27-year-old male and 16-year-old female presented with PD leaks secondary to a gunshot wound and blunt abdominal trauma, respectively. Both underwent intraoperative ERCP within an average of 5.9 h from time of presentation. A sphincterotomy and plastic pancreatic stent placement was performed with a 100% technical and clinical success. There were no associated immediate or long-term complications. Following discharge, both patients underwent repeat ERCP for stent removal with resolution of ductal injury.
These experiences further demonstrated that widespread adaption and optimal timing of ERCP may improve outcomes in trauma centers.
Core Tip: In the acute setting, intraoperative endoscopic retrograde cholangiopancreatography (ERCP) can effectively diagnosis and manage pancreatic duct (PD) injuries with stenting. At our high-volume trauma center, the on call therapeutic endoscopy team allows for quick and effective mobilization of resources. In this series, the time from admission to ERCP occurred within 6.3 and 5.6 h. The pancreatic injuries healed, and both stents were removed. In cases of traumatic PD injury, we believe that advanced gastroenterology care has the opportunity to improve the timing of diagnosis and treatment as a means to potentially reduce the morbidity and mortality associated with such injuries.