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[Gun-shot injuries to the abdomen involving the pancreas].

PURPOSE OF THE STUDY
The aim of the study is to present our experience with the diagnosis and therapy of penetrating abdominal injury involving the pancreas caused by a gun shot.


MATERIAL AND METHODS
The group included patients with gun-shot abdominal injuries involving the pancreas who were treated at the Department of Surgery and the Department of Emergency Medicine at the University Hospital Hradec Králové. The extent of pancreatic injury was assessed using the American Association for the Surgery of Trauma (AAST) classification. The factors evaluated included the timing of surgery, operative strategy, operative time, blood loss, post-operative complications with pancreatic fistulas in particular, and the length of hospital stay. Pancreatic fistula was assessed according to the ISGPF (International Study Group for Pancreatic Fistula). RESULTS During the period of study lasting 10 years, three patients with gun-shot abdominal injuries involving the pancreas were treated.


DISCUSSION
Pancreatic trauma due to a gun shot is a rare injury, but has also been reported in the Czech Republic. In any penetrating injury to the abdomen due to a gun shot, surgical exploration is always indicated and pancreatic trauma is usually found during the surgery. The first step in the procedure is to check all potential sources of bleeding because uncontrolled bleeding is the most frequent cause of intra-operative death. In a seriously injured patient, the technique of damage control surgery must be employed. After the major sources of bleeding have been checked, a thorough exploration of all abdominal organs should be performed to ascertain whether the main pancreatic duct has not been injured and, if so, in which part of the pancreas and to what extent. The correct classification of pancreatic injury according to the AAST is necessary to indicate appropriate therapy. Exploration for injury to other organs that often accompanies pancreatic trauma is a necessity.


CONCLUSIONS
Penetrating pancreatic trauma is almost always associated with injury to the adjacent organs. All patients with gun-shot injuries to the abdomen are indicated for surgical exploration, thus the pancreatic injury is often found at the surgical exploration. After bleeding has been controlled, for treatment of the injured pancreas, simple drainage, or suture of the pancreatic capsule, or pancreatic resection or a patch with an excluded jejunal loop can be used. Partial duodenopancreatectomy is the last option because this procedure is associated with high morbidity and mortality.