Case Series : Operative vs Non-Operative Management in Grade III Pancreatic Injury

Andry Irawan, Clinton Clinton, Sutanto D, Agustina F

Abstract


Introduction: Pancreatic injury is a rare case, caused by blunt or sharp trauma. Difficulty in making diagnose on pancreatic trauma cases are associated with high mortality, and the treatment can be either operative or conservatively. However, It is still unclear which treatment is more favorable.

Case: We present 2 cases of Grade III pancreatic injury with stable hemodynamic who suffered bicycle accident. First case, 12-year-old boy complaining severe pain on the upper left abdomen (VAS 9-10) and get worsening by time, with vomiting. The patient underwent distal Pancreatectomy-Splenectomy. Second case, 8-year-old boy complaining of pain on the upper left abdomen (VAS 6-7) without extension on whole abdominal region with vomiting and fever. The patient was treated conservatively. In both cases, patient was discharged with improvement. However, about 3 months later patients who were treated conservatively developed into a pseudocyst.

Conclusion: The selection of management in grade III pancreatic injury can be operative or conservative depending on clinical findings such as hemodynamic condition and the quality of abdominal pain. But the occurrence of pseudocysts pancreas is another surgical challenge.


Keywords


Pancreatic trauma; Distal Pancreatectomy; Pseudocysts



DOI: http://dx.doi.org/10.19166/med.v7i6.2598

Full Text:

PDF

References


1. Montalto M., Santoro L., D'Onofrio F., Gallo A., Campo S., Campo V. Endometriosis, need for a multidisciplinary clinical setting: The internist's point of view. Intern. Emerg. Med. 2010;5(6): 463–467. https://doi.org/10.1007/s11739-010-0404-7

2. Giudice L.C. Clinical practice. Endometriosis. N. Engl. J. Med. 2010;362(25): 2389–2398. https://doi.org/10.1056/NEJMcp1000274

3. Macafee C.H., Greer H.L. Intestinal endometriosis. A report of 29 cases and a survey of the literature. J. Obstet. Gynaecol. Br. Emp. 2016; 196067:539–555.

4. Ribeiro P.A., Rodrigues F.C., Kehdi I.P., Rossini L., Abdalla H.S., Donadio N. Laparoscopic resection of intestinal endometriosis: A 5-year experience. J. Minim. Invasive Gynecol. 2006;13(5):442–446. https://doi.org/10.1016/j.jmig.2006.05.010

5. Katsikogiannis N., Tsaroucha A., Dimakis K., Sivridis E., Simopoulos C. Rectal endometriosis causing colonic obstruction and concurrent endometriosis of the appendix: A case report. J. Med. Case Rep. 2011;5: 320. https://doi.org/10.1186/1752-1947-5-320

6. Al-Talib A., Tulandi T. Intestinal endometriosis. Gynaecol. Surg. 2010;7: 61–62. https://doi.org/10.1007/s10397-009-0516-0

7. Ribeiro H.S., Ribeiro P.A., Rossini L., Rodrigues F.C., Donadio N., Aoki T. Double-contrast barium enema and transrectal endoscopic ultrasonography in the diagnosis of intestinal deeply infiltrating endometriosis. J. Minim. Invasive Gynecol. 2008;15(3):315–320. https://doi.org/10.1016/j.jmig.2008.02.001

8. Pramateftakis M.G., Psomas S., Kanellos D., Vrakas G., Roidos G., Makrantonakis A. Large bowel obstruction due to endometriosis. Tech. Coloproctol. 2010;14(Suppl. 1): S87–9. https://doi.org/10.1007/s10151-010-0616-x

9. Harada T., Momoeda M., Taketani Y., Hoshiai H., Terakawa N. Low-dose oral contraceptive pill for dysmenorrhea associated with endometriosis: A placebo-controlled, double-blind, randomized trial. Fertil. Steril. 2008;90(5): 1583–1588. https://doi.org/10.1016/j.fertnstert.2007.08.051

10. Vercellini P., Frontino G., De Giorgi O., Pietropaolo G., Pasin R., Crosignani P.G. Continuous use of an oral contraceptive for endometriosis-associated recurrent dysmenorrhea that does not respond to a cyclic pill regimen. Fertil. Steril. 2003;80(3):560–563. https://doi.org/10.1016/S0015-0282(03)00794-5

11. Miller E.S., Barnett R.M., Williams R.B. Sigmoid endometriotic stricture treated with endoscopic balloon dilatation: Case report and literature review. Md. Med. J. 1990;39(12):1081–1084.

12. Whelton C., Bhowmick A. Acute endometrial bowel obstruction - A rare indication for colonic stenting. Int. J. Surg. Case Rep. 2013;4(2):160–163. https://doi.org/10.1016/j.ijscr.2012.11.007

13. Arafat S., Alsabek M.B., Almousa F., Kubtan M.A. Rare manifestation of endometriosis causing complete recto-sigmoid obstruction: A case report. Int. J. Surg. Case Rep. 2016;26. https://doi.org/10.1016/j.ijscr.2016.07.004


Refbacks

  • There are currently no refbacks.


Copyright (c) 2020 Andry Irawan, Clinton Clinton, Sutanto D, Agustina F

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

favicon Fakultas Kedokteran | Universitas Pelita Harapan | Lippo Karawaci, Tangerang, Indonesia, 15811