Presentation and Management of High-Grade Pancreatic Injuries: Case Series

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Abstract
Background: Trauma surgeons face a challenge in the management of high-grade pancreatic injuries (HGPIs), as optimal strategies remain controversial. HGPIs are uncommon and difficult to manage due to dynamic trauma physiology and complications from the injury and management. We aimed to evaluate HGPI presentations, management, and outcomes. Methods: This retrospective study included 13 patients with HGPIs (American Association for the Surgery of Trauma [AAST] grade III–V) who underwent interventions between 2017 and 2024. Results: There were 13 cases with HGPIs (five Grade III, four Grade IV, and four Grade V). Liver injury was the most common associated organ injury (61.5%), followed by splenic injury (46.2%). Distal pancreatectomy was the most frequently performed operation, with either concomitant splenectomy (53.8%) or spleen preservation (23.1%). Severe postoperative infection was observed in this cohort, with sepsis occurring in 69.2% of patients and peripancreatic collections noted in 76.9% and intra-abdominal infection in 61.5%. Other postoperative complications included ileus (61.5%), pancreatic fistula (30.8%), and diabetes (15.4%). Conclusions: This case series demonstrates that high-grade pancreatic injuries are associated with substantial morbidity, along with prolonged hospitalization. A higher Abbreviated Injury Scale (AIS) among HGPIs is associated with greater overall injury severity and higher rates of major complications. Clinicians should consider prioritizing early drainage procedures, particularly in Grade IV and V injuries. Multicenter and larger-sample-size studies are required.

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