Page 76 - World Journal of Laparoscopic Surgery

CASE REPORT
Laparoscopic Spleen-preserving Distal Pancreatectomy for

Grade III Pancreatic Injury: A Case Report

1
2
Murugappan Nachiappan , Ravikiran Thota , Srikanth Gadiyaram 3
Received on: 03 February 2022; Accepted on: 08 May 2022; Published on: 07 December 2022

AbstrAct
Aim: This article reports a case of grade III pancreatic injury managed by laparoscopic spleen-preserving distal pancreatectomy (SPDP). It also
discusses the management options available, the timing of surgery, and the surgical options with the review of available literature.
Background: Pancreatic surgery represents one of the most challenging areas in gastrointestinal surgery. Isolated pancreatic injury is uncommon
following abdominal trauma. Pancreatic transection with duct disruption following blunt abdominal trauma could be managed by both
conservative and surgical approaches. Complete pancreatic transection with duct disruption carries high morbidity and mortality. Distal pancreatic
resection along with splenectomy is the preferred surgical procedure. Laparoscopic distal pancreatectomy has gained worldwide acceptance
in recent years for non-traumatic cases. We report a case of grade III pancreatic injury in a 15-year-old girl managed with laparoscopic SPDP.
Case description: A 15-year-old girl presented to us with around 24 hours of blunt trauma to the upper abdomen. She was hemodynamically
stable. On examination abdomen was tender and there was voluntary guarding. Evaluation with contrast-enhanced computed tomography
(CECT) showed grade III pancreatic injury. There was no pneumoperitoneum. The rest of the solid organs were normal. After resuscitation in
line with advanced trauma life support (ATLS) protocols, she underwent a laparoscopic SPDP after written informed consent. She made an
uneventful recovery and was discharged on the sixth postoperative day. At the last follow-up, eight years after the surgery, she had no symptoms
of endocrine or exocrine insufficiency.
Conclusion: Laparoscopic SPDP for pancreatic trauma, though technically demanding and time-consuming, is a feasible undertaking in
hemodynamically stable patients.
Clinical significance: This case highlights that SPDP for grade III pancreatic injury could be accomplished laparoscopically. A minimally invasive
approach is feasible in patients with no associated injuries and hemodynamic stability. Early diagnosis and surgical management are crucial
for optimal outcomes.
Keywords: Duct disruption, Laparoscopy, Pancreas, Trauma.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1542

bAckgound 1–3 Department of Surgical Gastroenterology and MIS, Sahasra Hospital,
Pancreatic surgery represents one of the most challenging areas Bengaluru, Karnataka, India
in the field of gastrointestinal surgery. Isolated pancreatic injury is Corresponding Author: Srikanth Gadiyaram, Department of Surgical
uncommon following abdominal trauma. Pancreatic transection Gastroenterology and MIS, Sahasra Hospital, Bengaluru, Karnataka,
with duct disruption following blunt abdominal trauma could India, Phone: +91 9880109971, e-mail: srikanthgastro@gmail.com
be managed by both conservative and surgical approaches. How to cite this article: Nachiappan M, Thota R, Gadiyaram S.
Complete pancreatic transection with duct disruption carries high Laparoscopic Spleen-preserving Distal Pancreatectomy for Grade III
morbidity and mortality. Distal pancreatic resection along with Pancreatic Injury: A Case Report. World J Lap Surg 2022;15(3):
splenectomy is the preferred surgical procedure. Laparoscopic 262–265.
distal pancreatectomy has gained worldwide acceptance in Source of support: Nil
recent years for non-traumatic cases. We report a case of grade III Conflict of interest: None
pancreatic injury in a 15-year-old girl managed with laparoscopic
SPDP.
taken up for laparoscopic SPDP under general anesthesia in a
cAse description leg-split position after written informed consent. The port
placement was as shown in Figure 1B. Surgery was completed as
A 15-year-old girl presented to us around 24 hours of blunt trauma discussed in the following steps:
to the upper abdomen. She was hemodynamically stable. On
examination, the abdomen was tender and there was voluntary • Step 1. Exposure of the lesser sac: Gastrocolic omentum
guarding. Evaluation with a CECT showed a hematoma at the was taken down, hematoma visualized (Fig. 1C), and gastric
pancreatic neck and an enhancing pancreatic tissue in the distal traction suture was used to tag the stomach to parieties
body and tail of the pancreas suggestive of complete pancreatic (Fig. 1D).
transection and ductal disruption – grade III injury (Fig. 1A). There • Step 2. Evacuation of the hematoma with gentle suctioning.
was no pneumoperitoneum. The rest of the solid organs were • Step 3. Identification of the splenic vein: Splenoportal confluence
normal. After resuscitation in line with ATLS protocols, she was was identified after clearing the hematoma.

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