AB144. SOH24AB_177. A case of isolated pancreatic transection in trauma managed by spleen preserving distal pancreatectomy

Background: Pancreatic trauma results in high morbidity and mortality, it can often have an insidious or delayed presentation and can result in subsequent organ dysfunction. Given the anatomical relation of the spleen to the pancreas it is often resected during operative management due to the splenic vessels running through the tail of the pancreas. Spleen-preserving distal pancreatectomy (SPDP) is well established in benign and low-grade malignant disease due to its protective advantages in perioperative infectious complications, severe complications and length of hospital stay but it is rare to be a suitable procedure in the trauma setting.

Case Description: Our case is a 32-year-old female who presented following a farming accident. A large piece of farming equipment had closed on her upper abdomen resulting in a crush injury to her trunk. The patient self-mobilised away from the machinery and was brought emergently to hospital. Upon presentation, the patient was vitally stable and proceeded to computed tomography (CT) imaging which identified an isolated grade III pancreatic injury (radiological images). The intraoperative findings were a complete transection of neck of pancreas, with the superior mesenteric vein and portal vein visible posteriorly (intraoperative images). The spleen was preserved, distal pancreas removed and proximal pancreas closed with staple and oversewn. A Haemopatch and Robinson drain were placed in the pancreatic bed (intraoperative images).

Conclusions: To conclude, we believe that although SPDP for pancreatic trauma is rarely done and researched scarcely, this procedure is the better option for a haemodynamically stable patient if the expertise were available.

Keywords: Pancreatic injury; pancreatectomy; hepatobiliary; emergency surgery; trauma