Combination therapy with early nasopancreatic drainage and minimum surgery for blunt high-grade pancreatic trauma

Case: A 22-year-old man suffered blunt, high-grade, pancreatic trauma; however, duct-related complications were avoided by combining early nasopancreatic drainage with minimal surgery. Endoscopic retrograde pancreatography confirmed rupture of the main pancreatic duct and massive retroperitoneal extravasation. A nasopancreatic catheter was placed across the rupture site, laparotomy was carried out, and a grade IV pancreatic head laceration was sutured. Because the nasopancreatic catheter shifted out intraoperatively, another was inserted and left in place for 12 days. Outcome: The patient recovered well without any duct-related complications such as pseudocyst or external pancreatic fistula. Conclusion: A combination of early therapeutic endoscopic retrograde pancreatography and surgical repair may be useful for treating high-grade pancreatic trauma when pancreatic resection is unnecessary.