A Case Series Analysis of Pancreatic Injury Patients from Level 1 Trauma Centre

Abstract

Traumatic pancreatic injuries account for less than 1% of all traumas. These injuries are often associated with high-energy mechanisms, such as motor vehicle collisions, falls from heights, and penetrating injuries. We analyzed pancreatic trauma patients to determine outcomes following surgical or non-surgical management of traumatic pancreatic injuries. Once the diagnosis is made, patient management depends on multiple variables. We analysed the Level 1 trauma center database from 2019 to 2023. Data reviewed included patients’ demographics, mode of injury, grade of pancreatic injury, associated injuries, type of management, complications, and mortality, which were collected for analysis. Fifty-one patients with pancreatic injuries were included, with a median age of 34 years (19–58). Among these, 43(84%) were male, and 8 (15%) were female. Road traffic injuries were the most common cause of pancreatic injury. The mechanism of injury was blunt in 93% of cases and penetrating in 7%. The median injury grade was 3. Most injuries involved the pancreatic head (60%). The mean Injury Severity Score (ISS) at the presentation was 11. Nine patients (17.64%) were managed surgically, while the remaining were managed non-operatively. Ileus and associated organ injuries were the most significant factors predicting failure of non-operative management (NOM). Fourteen per cent of patients required total parenteral nutrition (TPN), most of whom were managed non-operatively. There were three needed readmissions, and no patient required re-operation. Mortality occurred in 7 patients (14%). Blunt trauma is the primary mechanism of pancreatic injuries, with road traffic accidents being the most common cause. While the majority of cases (84%) can be managed conservatively, a significant proportion (17.64%) required surgical intervention due to complex injuries or failure of non-operative management. Ileus and associated organ injuries are critical predictors of conservative management failure. Nutritional support in the form of TPN was frequently required, particularly in non-operatively managed patients. Mortality (14%) underscores the seriousness of pancreatic injuries, particularly in those with higher injury grades or complications. Pancreatic injuries, especially high-grade and delayed presentations, are associated with significant morbidity and mortality. Non-operative management was effective for low-grade injuries, while higher-grade injuries often required surgical intervention. Mortality correlated with polytrauma, high ISS, and physiological derangements. Early diagnosis, timely intervention, and multidisciplinary care are critical for improving outcomes. © Association of Surgeons of India 2025.