Embracing the Path of Least Resistance: Endoscopic Treatment of Traumatic Pancreatic and Hepatobiliary Injuries in Polytrauma Patients

Author(s): Jessica Chapelet, Angie Cardona, Bharti Sharma, Julia Torabi, Navin D Bhatia, Kate Twelker, Jasmine Dave, Juan Mestre, Zahra Shafaee, George Agriantonis, Jennifer Whittington, Monique Arnold

Objectives: Traumatic pancreatic and hepatobiliary injuries in polytrauma patients are associated with high morbidity and mortality, especially when resection is utilized. Managing these injuries is often complex, requiring a multidisciplinary approach.

Methods: This is a single-center, retrospective case series of adult polytrauma patients with pancreatic or hepatobiliary injuries (HPB) who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 1, 2021, and December 31, 2023, inclusive. Patients were identified using the Abbreviated Injury Scale (AIS) injury description and the causes of the injury.

Results: Seven patients underwent ERCP to manage HPB injuries. The mean age was 31 years, and six of the patients were male. Mechanisms of injury included blunt trauma (two gunshot wounds and two stab wounds), and penetrating trauma (two pedestrians struck and one motor vehicle accident). Six patients had intrahepatic biliary injuries, two had pancreatic duct injuries and one patient had both types of injury. Three of the four patients with intrahepatic injuries had biliary stents placed with a resolution of bile leak; the fourth underwent only sphincterotomy and required repeat ERCP with biliary stenting for persistent leak. Three of these patients had bilomas, requiring percutaneous drainage by interventional radiology. Of the patients with pancreatic duct injuries, all three were stented to prevent pancreatitis. The patient with both a biliary and pancreatic leak required percutaneous drainage for the pancreatic leak. The mean time to ERCP was 8 days. There were no post-ERCP complications. The mean follow-up time was 790 days and there was no reported mortality.

Conclusion: Polytrauma patients with HPB injuries should be monitored for biliary and pancreatic leaks and high suspicion for these leaks should be maintained. Endoscopic therapies provide effective treatment for HPB injuries, and surgical drains placed during the initial surgery facilitate early diagnosis of leaks and prompt endoscopic intervention.