# Management and Clinical Outcomes of Pancreaticoduodenal Injuries at a Tertiary Care Centre in Southern India

## TL;DR

This study examines the management and outcomes of pancreaticoduodenal injuries at a hospital in southern India, emphasizing the importance of early diagnosis and treatment.

## Contribution

The study provides insights into the clinical management and outcomes of pancreaticoduodenal injuries in a specific geographic and healthcare context.

## Key findings

- Most patients were male and had blunt trauma as the primary cause.
- Nonoperative management was successfully used in some high-grade pancreatic injuries.
- Delayed admission increased postoperative morbidity significantly.

## Abstract

Objective: Pancreaticoduodenal injuries are complex, and early diagnosis is often missed due to their retroperitoneal location. Serial clinical monitoring and imaging are essential for the management of these injuries. Morbidity and mortality increase in patients with delayed presentation. The aim of this study is to analyse the demography, mode of presentation, grading, management, morbidity and mortality of these injuries at our centre.

Methods: This is an ambispective study conducted on 31 patients over a period of five years, between October 1, 2019 and October 15, 2024.

Results: Most patients were male (93.5%). Blunt trauma was associated with the majority of cases (83.8%). Twenty-nine patients were hemodynamically stable on arrival at the trauma/emergency ward. Postoperative morbidity was around 32% in our study, whereas mortality was approximately 7%. Nonoperative management was followed in five cases of high-grade (Grade 4) pancreatic injury. One patient with Grade 5 pancreaticoduodenal injury underwent an emergency Whipple procedure. In our study, postoperative morbidity associated with delayed admission beyond 48 hours from the time of injury was statistically significant (p = 0.029).

Conclusion: A high index of suspicion is needed in every case. Delayed diagnosis and treatment negatively impact morbidity and mortality. In selected cases of high-grade pancreatic injuries, conservative management with serial follow-up and imaging can be considered at a well-equipped tertiary care centre.