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Injury or trauma to the liver and pancreas

Pancreatic trauma

Penetrating isolated injuries to the pancreas can occur as a result of stab wounds or impalement. In rare cases, pancreatic injuries are observed in children due to fracture over the vertebrae or direct abdominal blows. Penetrating injuries to the pancreas can also be caused due to firearms otherwise known as gunshot wounds (GSW). For lower grades of blunt pancreatic injuries, surgical intervention may not be required. Trauma to the head region of pancreas is often more complex because, it is usually associated with injury to the duodenum, bile duct and sometimes to the portal vein (the major vein which carries blood to the liver). This type of injury would warrant immediate expert surgical treatment. These patients may need multiple operations to repair the injury. In case of a penetrating trauma to the pancreas, the tail and body of the pancreas are removed.

Diagnosis of pancreatic trauma

Physical examination:

Flank ecchymoses

Seat belt marks

Retroperitoneal haematoma manifests as epigastric pain or back pain

Blood and lab studies:

Amylase and lipase levels are usually elevated

DPL diagnostic peritoneal lavage

Imaging:

Plain films of the abdomen

CT scan

MRCP or magnetic cholangiopancreatography

Multidetector CT with MRI

Intraoperative cholangiogram (to assess bile duct injury)

Pancreatic ductogram (to assess the integrity of the pancreatic duct)

Liver trauma

The liver is a solid organ and is always in a fixed position. Due to this characteristic, the liver is prone to injury. Liver traumas are common and are usually as a result of a vehicular collision. Traumas of the liver are graded from least severe to most severe (grade 1 to 5). All liver traumas may not require surgery. Higher grades of liver injury, if causing significant bleeding to cause fall in blood pressure and more number of blood transfusions, will require surgery. The tear on the liver is stitched and repaired. In higher grades of injuries, a part of the devitalized liver tissue needs to be removed during surgery. Surgery for liver trauma requires high level of expertise and team work.

Diagnosis for liver trauma

Plain radiographs to evaluate rib and spinal injuries

CT scan contrast enhanced CT scan

MRI

Ultrasonography (as an initial assessment tool)

Angiography localizes the site of the haemorrhage (in case of delayed bleeding or pseudoaneurysm)

Dr. Deepak Varma and his team have performed several complex pancreatic and liver trauma operations in their facility for more than two decades.