Management of adult pancreatic injuries: A practice management guideline from the Eastern Association for the Surgery of Trauma.

Background: Traumatic injury to the pancreas is rare but is associated with significant morbidity and mortality, including fistula, sepsis, and death. There are currently no practice management guidelines for the medical and surgical management of traumatic pancreatic injuries. The overall objective of this article is to provide evidence-based recommendations for the physician who is presented with traumatic injury to the pancreas. Methods: The MEDLINE database using PubMed was searched to identify English language articles published from January 1965 to December 2014 regarding adult patients with pancreatic injuries. A systematic review of the literature was performed, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was employed to formulate evidence-based recommendations. Results: Three hundred nineteen articles were identified. Of these, 52 papers underwent full text review and 37 were selected for guideline construction. Conclusions: Patients with grade I/II injuries tend to have fewer complications; for these, we conditionally recommend nonoperative or non-resectional management. For grade III/IV injuries identified on CT or at operation, we conditionally recommend pancreatic resection. We conditionally recommend against the routine use of octreotide for post-operative pancreatic fistula prophylaxis. No recommendations could be made regarding the following two topics: optimal surgical management of Grade V injuries; and the need for routine splenectomy with distal pancreatectomy. (C) 2016 Lippincott Williams & Wilkins, Inc.

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