Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review

Optimal treatments for hepato-pancreato-biliary trauma in severely injured patients: a narrative scoping review

Can J Surg 2020;63(5):E431-E434 | PDF

Lucas Streith, MD*; Jenna Silverberg, BSc*; Andrew W. Kirkpatrick, MD; S. Morad Hameed, MD; Oliver F. Bathe, MD; Chad G. Ball, MD

Summary

Hepato-pancreato-biliary (HPB) injuries can be extremely challenging to manage. This scoping review (8438 citations) offers a number of recommendations. If diagnosis and therapy are rapid, patients with major hepatic injuries who present in physiologic extremis have high survival rates despite prolonged hospital stays. Nonoperative management of major liver injuries, as diagnosed using computed tomography, is typically successful. Adjuncts (e.g., angioembolization, laparoscopic washouts, biliary stents) are essential in managing high-grade injuries. Injury to the extrahepatic biliary tree is rare. Cholecystectomy is indicated for all gallbladder trauma. Full-thickness common bile duct injuries require a hepaticojejunostomy, although damage control remains closed suction drainage. Injuries to the pancreatic head often involve concurrent trauma to regional vasculature. Damage control necessitates drainage after stopping hemorrhage. Injury to the left pancreas commonly requires a distal pancreatectomy. Outcomes for high-grade pancreatic and liver injuries are improved by involving an HPB team. Complications are multidisciplinary and should be managed without delay.


This study was presented at Canadian Surgery Forum in Montreal, Quebec, Canada on September 5, 2019.

*These authors contributed equally to this work.

Accepted Dec. 18, 2019

Affiliations: From the Department of Surgery, University of Calgary, Calgary, Alta. (Streith, Silverberg, Kirkpatrick, Bathe, Ball); and the Department of Surgery, University of British Columbia, Vancouver, BC (Hameed).

Competing interests: C. Ball is co-editor in chief of CJS; he was not involved in the review or decision to accept this manuscript for publication. No other competing interests were declared.

Contributors: All authors contributed substantially to the conception, writing and revision of this article and approved the final version for publication.

DOI: 10.1503/cjs.013919

Correspondence to: C. Ball, 1403-29 St NW, Foothills Medical Centre, Calgary AB T2N 5A1, ball.chad@gmail.com