The acute posttraumatic pancreatitis is not exceptional, it is the second complication after pancreatic fistulas, it’s common in 2-6% of cases. We carried out a retrospective study starting from five cases observed from January 2008 to August 2012 at the surgical intensive care unit of the university hospital Ibn Rochd of Casablanca. The diagnosis was carried out by tomodensitometry in three cases and during an exploring laparotomy in both other cases.Through this work various approaches were studied such as the etiological, clinical, progressive and therapeutic aspects for this disease. The clinical manifestations have nothing particular with regard to the other etiologies of pancreatitis. The biological examinations with diagnostic aim, which are dominated by the serum dosage of the amylase, lack sensibility and particularly specificity especially in this traumatic context. The TDM is the reference examination which allows the exploration of the pancreatic gland and the detection of the pancreatic canals when it is realized in spiral mode. In 60 % of these cases the scanner contributed effectively to confirm the diagnosis of the acute pancreatitis after trauma. The scanner highlighted at one of our patients the rupture of the canal of Wirsung. At various stages of development, the repeated use of the TDM allowed to feature locoregional complications (stream of necrosis in 20 % of the cases, and FKP in 20 % of the cases). The search for a ductal lesion is an essential stage in the handling of a trauma of the pancreas with or without associated pancreatitis. The prognosis depends largely on its early surgical repair. The CPRE, the Wirsungography, the MRI and recently the helicoidal scanner can reveal this lesion. The prognosis of the post-traumatic pancreatitis follows the usual criteria of the other etiologies. The only difference is that it depends on the existence or not of a ductal lesion, on its nature, on its location and on its therapeutic approach .The score of Ranson, which remains a reliable score for the estimation of the gravity of pancreatitis, is with difficulty applicable in the traumatic context. This score was not calculated in our series. The medical treatment of pancreatitis occurring after trauma is comparable to the other etiologies of the pancreatitis, the association of the medical treatment in the surveillance in order to detect possible infectious complications is recommended by all the authors. The surgical attitude depends on the initial lesional assessment. In the absence of ductal lesion, a simple drainage is recommended. In the presence of a ductal lesion or a complete tear of the head of pancreas, a pancreatic resection is better than reconstruction in this context of tissue bruise. Otherwise, we certainly think that the treatment should be early surgery.
| Référence | 1725 |
| Année | 2012 |
| Type | Thèse |
| Lien document | |
| Auteur | El azaoui N |
| Discipline | Centre Hospitalier Universitaire Ibn Rochd Casablanca |
| Encadrant | Bouhouri MA |
