Our Summary

The research paper discusses injuries to the duodenum, pancreas, and extrahepatic biliary tree, which are the parts of the body that help digest food. These types of injuries are rare but can be serious due to the organs’ location inside the body. The severity of such injuries can be influenced by other associated injuries, and even when the injury is isolated, it can still cause significant health problems.

The ideal way to treat these injuries largely depends on factors such as the patient’s overall stability, how the injury presents itself, and its severity. The paper mentions that non-surgical treatments, such as endoscopic and percutaneous interventions, have improved our ability to manage these injuries.

However, if these injuries are not diagnosed and treated promptly, they can lead to increased health problems and even death. The paper also notes that complications from severe pancreatic trauma and late presentation of pancreatic injury are now more often addressed with endoscopic procedures and interventional radiology.

Nevertheless, for severe injuries to the duodenum, pancreas, and extrahepatic biliary tree, immediate surgical intervention is usually preferred because associated injuries are frequent and often present with instability or peritonitis, a severe abdominal infection.

The paper aims to present the guidelines for managing trauma to the duodenum, pancreas, and extrahepatic biliary tree, as established by the World Society of Emergency Surgery (WSES) and the American Association for the Surgery of Trauma (AAST).

FAQs

  1. What factors primarily dictate the optimal management of duodeno-bilio-pancreatic injuries?
  2. How have endoscopic and percutaneous interventions impacted the management of duodeno-pancreatic and extrahepatic biliary tree injuries?
  3. When is immediate operative intervention preferred for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries?

Doctor’s Tip

One helpful tip a doctor might tell a patient about bile duct surgery is to follow post-operative care instructions closely to help ensure a successful recovery. This may include taking prescribed medications, avoiding certain foods or activities, and attending follow-up appointments as directed. It is also important to communicate any concerning symptoms or changes in condition to your healthcare provider promptly.

Suitable For

Patients who are typically recommended for bile duct surgery include those with moderate to severe extrahepatic biliary tree injuries, severe duodeno-pancreatic injuries, and associated injuries that present with hemodynamic instability or peritonitis. Additionally, patients with late diagnosis and treatment of pancreatic injuries or complications of severe pancreatic trauma may also be candidates for bile duct surgery. The decision for surgery is based on factors such as hemodynamic stability, clinical presentation, and grade of injury, with the goal of reducing morbidity and mortality associated with these complex injuries. Various interventions, including endoscopic and percutaneous procedures, may be considered before surgical intervention in select cases.

Timeline

  • Before bile duct surgery:
  1. Trauma or injury to the duodeno-pancreatic and extrahepatic biliary tree
  2. Initial evaluation and assessment of the severity of the injury
  3. Hemodynamic stability and clinical presentation determine the management approach
  4. Non-operative interventions such as endoscopic or percutaneous procedures may be attempted for less severe injuries
  5. Associated injuries are common and may impact the overall management and outcome
  • After bile duct surgery:
  1. Immediate post-operative recovery period in the hospital
  2. Monitoring for complications such as infection, bleeding, or bile leakage
  3. Gradual resumption of normal activities and diet under medical supervision
  4. Follow-up appointments for monitoring and evaluation of surgical outcomes
  5. Long-term management of any ongoing issues related to the bile duct surgery, such as bile duct strictures or other complications.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with bile duct surgery?
  2. What is the success rate of bile duct surgery?
  3. How long is the recovery process after bile duct surgery?
  4. Will I need any additional treatments or procedures after the surgery?
  5. How will bile duct surgery affect my daily activities and quality of life?
  6. Are there any dietary or lifestyle changes I should make after bile duct surgery?
  7. What follow-up appointments or monitoring will be necessary after the surgery?
  8. How will bile duct surgery impact my overall health in the long term?
  9. Are there any alternative treatment options to consider before undergoing bile duct surgery?
  10. How experienced are you in performing bile duct surgery, and what is your success rate with this procedure?

Reference

Authors: Coccolini F, Kobayashi L, Kluger Y, Moore EE, Ansaloni L, Biffl W, Leppaniemi A, Augustin G, Reva V, Wani I, Kirkpatrick A, Abu-Zidan F, Cicuttin E, Fraga GP, Ordonez C, Pikoulis E, Sibilla MG, Maier R, Matsumura Y, Masiakos PT, Khokha V, Mefire AC, Ivatury R, Favi F, Manchev V, Sartelli M, Machado F, Matsumoto J, Chiarugi M, Arvieux C, Catena F, Coimbra R; WSES-AAST Expert Panel. Journal: World J Emerg Surg. 2019 Dec 11;14:56. doi: 10.1186/s13017-019-0278-6. eCollection 2019. PMID: 31867050