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Peculiarities of the diagnosis and treatment of traumatic pancreatic injuries


Author: Sergiu Berliba
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2007
Scientific adviser: Gheorghe Ghidirim
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 13 December, 2006
Approved by NCAA on the 18 January, 2007

Abstract

Adobe PDF document0.26 Mb / in romanian

Thesis

CZU 616.37-001-07-089

Adobe PDF document 1.60 Mb / in romanian
138 pages


Keywords

pancreas, traumatism, primary control laparastomy, acute posttraumatic pancreatitis

Summary

The paper is based on the analysis of the treatment results of 229 patients with traumatic pancreatic injuries, hospitalized in the period 1992-2004 at National Scientific Practical Clinic of Emergency Medicine. The age of traumatized patients varied from 5 to 72 years, mean 33,41±0,84 years. The majority of the patients were suffering from closed abdominal trauma (66,4%), direct pancreatic injury prevailed in 46,1%. A major share of multiple and associated injuries was registered (51,5% and 35,8%). Clinical diagnosis was established only in 29 (19,1%) patients with closed isolated pancreatic traumatism, who at hospitalization showed characteristic clinical signs of posttraumatic acute pancreatitis (PAP). Diagnostic laparoscopy was performed in 26,6%(61 cases), in 47,5% were encountered indirect signs of traumatic pancreatic injury. Medical-surgical tactics depended on the mechanogenesis of lesions, gravity of traumatism and hemodynamics of hospitalized patients. Depending on clinical, laboratory and instrumental data 28(12,2%) patients were treated nonsurgically. 201 patients were operated depending on the gravity of pancreatic injury registered during surgery and hemodynamic state of the patients, by means of closed or open laparastomy. During early postoperative period 28 patients with closed drainage of omental bursa underwent relaparotomy and application of planned laparastomy due to the development of posttraumatic pancreatic necrosis. A major importance in the operative course of patients with closed drainage of omental bursa presents planned necrectomies. In the postoperative period in patients that underwent relaparotomy was studied the dynamics of clinical and laboratory index that characterizes the syndrome of endogenous intoxication, with an evident decrease of it after necrectomies. High rate of complications and mortalities were registered in patients from III-V injury groups (25%) and depending on the character of the surgery in those that primarily underwent revision, hemostasis and drainage of omental bursa.

Late complications were registered in 28(14,2%) patients via the development of posttraumatic pancreatic fistulas, treated conservatively (71,4%) and surgically (28,6%).

The obtained results are demonstrating that the correct assessment of the gravity and hemodynamics of patients with traumatic pancreatic injuries, as well as the selection of adequate medical-surgical tactics, allowed us to decrease the frequency.