Abstract
Background
Pancreatic injuries are uncommon but result in substantial morbidity and mortality. This study evaluated the factors associated with morbidity and mortality in civilian patients with pancreatic gunshot wounds.
Methods
This was a single-institution, retrospective review of patients with gunshot wounds of the pancreas treated from 1976 to 2009 in Cape Town, South Africa. Univariable and multivariable analyses were performed.
Results
A total of 219 patients (205 male, median age 27 years) had pancreatic American Association for the Surgery of Trauma grade IโII (111 patients) and grade IIIโV (108) gunshot injuries to the pancreatic head (72), neck (8), body (75) and tail (64). The patients underwent 239 laparotomies, including drainage of the pancreas (169), distal pancreatectomy (59) and pancreaticoduodenectomy (11). Some 218 patients had 642 associated intra-abdominal and 91 vascular injuries. Forty-three (19ยท6 per cent) required an initial damage control procedure. A total of 150 patients (68ยท5 per cent) had 407 postoperative complications (median 4, range 1โ7). The 46 patients (21ยท0 per cent) who died had a median of 3 (range 1โ7) complications. Median (range) intensive care unit and total hospital stay were 5 (1โ153) and 11 (1โ255) days respectively. Multivariable analyses identified age, high-grade pancreatic injury, associated vascular injuries and need for repeat laparotomy as predictors of morbidity. Age, shock on admission, need for damage control surgery, high-grade pancreatic injuries and associated vascular injuries were significant factors associated with mortality.
Conclusion
Morbidity and mortality rates were high after gunshot injuries to the pancreas. Initial shock and severe injury combined with need for damage control surgery were associated with the highest risk of death.