{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T11:30:32Z","timestamp":1792668632048,"version":"4.5.0"},"reference-count":48,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2009,6,4]],"date-time":"2009-06-04T00:00:00Z","timestamp":1244073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2009,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>In hemodynamically stable patients after blunt pancreatic trauma, the main pancreatic duct (MPD) disruption (American Association for the Surgery of Trauma [AAST] grade III\u2010IV\u2010V lesions) is usually treated surgically or by endoscopic stent placement, whereas injuries without duct involvement (grade I\u2010II) are liable to medical treatment. To date, no evidence has been reported regarding nonoperative management (NoM) of grade III injuries. We aimed to evaluate the safety of extending medical management to include cases of distal MPD involvement (grade III).<\/jats:p><\/jats:sec><jats:sec><jats:title>Patients and methods<\/jats:title><jats:p>Data were collected on patients admitted after blunt pancreatic trauma between January 1999 and December 2007. Patients exhibiting hemodynamic instability or hollow organ perforations were excluded from this study, as they were surgically managed. In all remaining cases NoM was attempted. Antibiotic prophylaxis and early total enteral nutrition were routinely adopted. Grade III patients received octreotide during hospitalization and for 6\u00a0months after discharge.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Eleven patients (2 with grade I injury, 3 with grade II injury, and 6 with grade III injury, all diagnosed by contrast\u2010enhanced helical CT) were included. Nonsurgical management was carried out in all of these patients. Among grade III patients, one developed a peripancreatic abscess; another, a pancreatic fistula. Both were successfully treated nonoperatively. The average length of hospital stay was similar in grade I\u2010II and grade III patients. After a median follow\u2010up of 57\u00a0months no mortality or pancreatic sequelae had occurred.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Under the aforementioned conditions<jats:bold>,<\/jats:bold> an attempt to extend NoM to include patients with AAST\u2010grade III lesions can be justified. However, such a strategy demands continuous patient monitoring, because should the case worsen, surgery might become necessary.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-009-0082-7","type":"journal-article","created":{"date-parts":[[2009,6,5]],"date-time":"2009-06-05T23:47:50Z","timestamp":1244245670000},"page":"1611-1617","source":"Crossref","is-referenced-by-count":37,"title":["Extension of Nonoperative Management of Blunt Pancreatic Trauma to Include Grade III Injuries: A Safety Analysis"],"prefix":"10.1002","volume":"33","author":[{"given":"Giacomo","family":"Pata","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, 1st Division of General Surgery University of Brescia Viale Europa, 11 25123 Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Casella","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, 1st Division of General Surgery University of Brescia 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