Michael Clemens, MD, Thomas Mitchell, MD, Timothy Vreeland, MD, Christopher White, Lorne Blackbourne. San Antonio Military Medical Center
Introduction: Pancreatic injury in an austere environment is associated with significant morbidity and mortality.
Methods: A retrospective evaluation of all patients who underwent exploratory laparotomy from January 2002 – September 2011 during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) was performed for patients who survived a minimum of 24 hours. Inclusion criteria for this study relied upon patients undergoing exploratory laparotomy with an ICD-9 procedure code(s) of 52.09 (Other pancreatotomy), 52.52 (Distal Pancreatectomy), 52.6 (Total Pancreatectomy), 52.95 (Other repair of the pancreas), 52.96 (Anastomosis of the pancreas), or 52.9 (Other operations on pancreas). Patient demographic information, surgical complications, and in-theater mortality was evaluated while the patients were treated at a North American Treaty Organization Role II and III medical treatment facilities.
Results: Twenty-five patients out of 1,248 total patients undergoing exploratory laparotomy were identified to have a pancreatic surgical procedure while in a deployed theater environment. The mean Injury Severity Score and abdominal Abbreviated Injury Score were 32.8 + 13.9, and 3.7 + 1.0, respectively. Operation Iraqi Freedom, 64% (16/25) accounted for the majority of injuries. The dominant mechanisms of injury included explosive devices, 56% (14/25), and bullet/gunshot wound/firearm, 36% (9/25). The three most common ICD-9 procedure codes were 52.52, 44% (11/25), 52.95, 24% (6/25), and 52.6, 16% (4/25). Each patient had an average of two additional procedures on different organ systems in addition to their pancreatic procedure. The most common anatomical organ systems injured requiring concomitant repair were spleen, 72% (18/25), colon, 36% (9/25), and stomach/diaphragm 20% (5/25) apiece. No intra-abdominal complications were denoted while in a NATO Role II or III MTF. All 25 patients were discharged from theater alive to Landstuhl, Germany.
Conclusion: Pancreatic injury in theater results predominantly from explosive devices with significant concomitant associated anatomical injury. All patients surviving a minimum of 24 hours with a pancreatic injury survived to transfer from the NATO Role III MTF. Further investigation is warranted into acute operative management strategies in a combat environment for pancreatic injuries.