•Hospital-based study conducted from MAY 2004 to JAN 2008.
•164 patients who underwent CT following blunt trauma prior to surgery were included in the study.
•Data analyzed by SPSS 15.
Selection Criteria of the patient:
•Patients with blunt abdominal trauma who underwent CT for evaluation of intra-abdominal injury prior to surgery.
Exclusion Criteria of the patient:
•Patients who did not have a follow up (laparotomy / follow up imaging if managed conservatively) were excluded.
COMPUTED TOMOGRAPHY:
•DIRECT FINDINGS •Pancreatic enlargement +/-
•Laceration (focal linear nonenhancement) +/-
•Contusion / hematoma / disruption +/-
•Inhomogeneous enhancement +/-
•SECONDARY FINDINGS
•Peripancreatic fat stranding +/-
•Peripancreatic fluid collections +/-
•Fluid between the splenic vein and pancreas +/-
•Thickening of the left anterior pararenal fascia +/-
•COMPLICATIONS
•Fistula +/- •Pseudocyst +/- •Abscess +/- Pancreatitis +/-
Pancreatic Injury Scale :
Grade |
Injury type |
Description of injury |
I |
Hematoma Laceration
|
Minor contusion without duct injury
Superficial laceration without duct injury
|
II |
Hematoma
Laceration
|
Major contusion without duct injury or tissue loss
Major laceration without duct injury or tissue loss
|
III
|
Laceration
|
Distal transection or parenchymal injury with duct injury
|
IV
|
Laceration
|
Proximal transection or parenchymal injury involving
ampulla
|
V
|
Laceration
|
Massive disruption of pancreatic head
Source: Moore E et al. Journal of Trauma 1990
|
CT AND MANAGEMENT CORRELATION:
The accuracy of the CT was evaluated on the basis of the final radiology report which were compared with either
1) Findings at laparotomy
2) Findings at follow up imaging if managed conservatively.
MANAGEMENT:
Conservative: yes/no
Follow up: recovered / deteriorated / died
OPERATIVE:
Emergency laparotomy yes/no
Emergency laparoscopy yes/no
Delayed laparotomy / laparoscopy yes/no
If operated: AAST & CT finding correlation
Follow up: recovered / deteriorated / died
STATISTICAL ANALYSIS:
•Correlations between different variables examined by using Spearman’s test. •Agreement for the scoring system, other factors guarding management calculated by Kappa value. •Means of continuous variables compared by using the paired Student’s t test. •Intragroup multiple comparisons determined by Welch's ANOVA.
IMAGING FINDINGS:
•Out of 164 patients, 33 (21%) patients had BPT . •The mean age was 30 yrs, and 86 % were male.
•68 % of patients had CT done within 12 hrs of the trauma. •The major cause of BPT in our study was RTA (60%).
|
Present study |
Al-Ahmadi et al (2008) 253 |
Kantharia et al (2007) 252 |
Lin et al (2004) 254 |
Bedirli et al (2003) 255 |
Ilahi O et al (2002) 131 |
Akhrass et al (1997) 30 |
% successful Conservative Rx |
35% |
48% |
41% |
- |
- |
22% |
37% |
% surgcial rx |
65% |
52% |
59% |
- |
- |
78% |
63% |
% distal pancrea- tectomy |
57% |
46% |
60% |
62.5% |
70% |
- |
- |
% proximal pancrea- tectomy |
43% |
54% |
40% |
37.5% |
30% |
- |
- |
% Delayed complication Rx |
51.5% |
- |
- |
- |
- |
- |
- |
•21 % of the cases sustained pancreatic injury with laceration being the most common finding on CT. •Fluid around the splenic vein was taken as independent criteria and its efficacy was evaluated in diagnosing pancreatic injury. •This finding was seen in 18 patients.
•Conservative management was done for 26 (78.8%) patients and was successful in 9 (27.3%) patients.
•All the successful conservatively managed patients were of AAST grade < III.
•17(65%) patients had failed conservative management and required delayed drainage procedure.
•24 patients underwent surgical intervention and had BPT at the time of surgery .
•Overall delayed pseudocyst management was required in 17 (52%) patients.
•24 patients had confirmed pancreatic injury at the time of surgery (PPV = 100%) and correlation between operative findings and CT was 86.6%.
•CT underestimated pancreatic injury in the remaining 13.4%.
•Overall CT scan was 100 % (28 of 28) accurate in diagnosing BPT.
Surgical Management
|
Present study
|
Lin et al (2004)254
|
Bedirli et al (2003)255
|
Akhrass et al (1997)30
|
I
|
8.5%
|
-
|
-
|
-
|
II
|
50%
|
-
|
-
|
-
|
III
|
100%
|
97%
|
100%
|
100%
|
IV
|
100%
|
100%
|
100%
|
100%
|
V
|
100%
|
100%
|
100%
|
100%
|
NEED FOR SURGERY CORRELATION
|
ODDS RATIO
|
CONFIDENCE LIMITS (95%)
|
KAPPA
|
P VALUE
|
AAST GRADE
|
1.8
|
1.2
|
2.7
|
0.380
|
0.006
|
LACERATION
|
30.4
|
3.0
|
303.4
|
0.598
|
0.001
|
PANCREATITIS
|
0.003
|
0.003
|
0.328
|
- 0.492
|
0.001
|
CRITERION
|
Present study
|
Duchesne et al (2008)256
|
Al-Ahmadi et al (2008)253
|
Lin BC et al (2004)254
|
Kao LS et al (2003)257
|
AAST grade
|
P <0.0006
|
-
|
P < 0.05
|
P < 0.05
|
-
|
Laceration
|
P <0.0001
|
-
|
P < 0.05
|
P < 0.05
|
P < 0.05
|
Pancreatitis
|
P <0.0001
|
p < 0.05
|
-
|
-
|
-
|
COMPLICATIONS/ INTERESTING FINDINGS
COMPLICATIONS/ INTERESTING FINDINGS
|
NO OF CASES
|
PSEUDOCYST
|
12
|
INFECTED PSEUDOCYST
|
2
|
PANCREATIC FISTULA
|
1
|
PANCREATIC ASCITES
|
2
|