Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

World J Emerg Surg. 2019 Dec 11:14:56. doi: 10.1186/s13017-019-0278-6. eCollection 2019.

Abstract

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines.

Keywords: Adult; Ampulla; Bile duct; Biliary tree; Classification; Conservative; Duodenum; Endoscopic retrograde cholangiopancreatography (ERCP); Endoscopy; Guidelines; Injury; Non-operative; Operative; Pancreas; Pediatric; Surgery; Trauma.

Publication types

  • Review

MeSH terms

  • Abdominal Injuries / surgery
  • Bile Ducts, Extrahepatic / injuries*
  • Bile Ducts, Extrahepatic / surgery
  • Duodenum / injuries*
  • Duodenum / surgery
  • Focused Assessment with Sonography for Trauma / methods
  • General Surgery / organization & administration
  • General Surgery / trends
  • Guidelines as Topic
  • Humans
  • Pancreas / injuries*
  • Pancreas / surgery
  • Tomography, X-Ray Computed / methods
  • Trauma Centers / organization & administration
  • Triage / methods
  • Ultrasonography / methods