WordNet

any physical damage to the body caused by violence or accident or fracture etc. (同)hurt, harm, trauma
an act that causes someone or something to receive physical damage
wrongdoing that violates anothers rights and is unjustly inflicted
an accident that results in physical damage or hurt (同)accidental injury
of or involving the pancreas; "pancreatic cancer"

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『負傷』,『損害』,損傷 / (名誉などを)傷つけること,侮辱《+『to』+『名』》
膵臓の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/25 22:50:51」(JST)

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A pancreatic injury is some form of trauma sustained by the pancreas. The injury can be sustained through either blunt forces, such as a motor vehicle accident, or penetrative forces, such as that of a gunshot wound.^[1] The pancreas is one of the least commonly injured organs in abdominal trauma.^[2]

Management

Diagram of the pancreas, showing its relation to the duodenum and the mesenteric veins and arteries

Diagnosis

The diagnosis of this form of injury can be challenging because of the pancreas' location inside the abdomen.^[3] The use of ultrasound can reveal fluid around the site of injury.^[1] Computed tomography (CT) can also be utilized as a non-invasive diagnostic tool,^[3] but its reliability is low; one retrospective case review found that computed tomography had either failed to find injuries or had underestimated the severity of injury in more than half of 17 pancreatic injury patients.^[4] Serum amylase has also been shown to be of limited diagnostic utility within the first three hours following injury.^[4] Management of a pancreatic injury can be difficult because other abdominal organs, such as the liver, usually have sustained trauma as well.^[3]^[5] Several common symptoms manifest hours after the injury such as tachycardia, abdominal distension, and midepigastric tenderness.^[5] Indications for surgical intervention include: peritonitis based on physical examination; hypotension in combination with a positive focussed assessment with sonography (ultrasound) for trauma (FAST); and pancreatic duct disruption based on the results of thin-cut computed tomography or endoscopic retrograde cholangiopancreatography (ERCP).^[3] Commonly, a laparotomy is done in order to directly visualize the injury, and generally this approach is the most accurate diagnostic method.^[1]^[5]

Classification

1: Head of pancreas
2: Uncinate process of pancreas
3: Pancreatic notch
4: Body of pancreas
5: Anterior surface of pancreas
6: Inferior surface of pancreas
7: Superior margin of pancreas
8: Anterior margin of pancreas
9: Inferior margin of pancreas
10: Omental tuber
11: Tail of pancreas

12: Duodenum

Pancreatic injuries are classified according to the criteria of the American Association for the Surgery of Trauma (AAST). The grade of the trauma should be increased by one level for multiple injuries to the same organ. The description of the injury is that "based on most accurate assessment at autopsy, laparotomy, or radiological study." The pancreatic organ injury scale, as minimally modified, is:^[4]^[6]

**The Pancreatic Injury Scale classification**
Grade	Subcapsular hematoma	Laceration
I	Minor contusion without ductal injury	Superficial laceration without ductal injury
II	Major contusion without duct injury or tissue loss	Major laceration without duct injury or tissue loss
III	Distal transection or parenchymal injury with duct injury
IV	Proximal transection or parenchymal injury, not involving ampulla
V	Laceration-Massive disruption of pancreatic head

Surgical treatment

When there is no pancreatic duct injury, typically hemostasis and surgical drainage are the main form of treatment.^[1]^[3]^[4] Surgical repair is undertaken when there is evidence or suspicion of ductal injury.^[4] The type of surgery depends on the degree of the injury and its proximity to the mesenteric blood vessels that serve the pancreas. When injuries are not close to the mesenteric vessels, a distal pancreatectomy may be done; this procedure preserves much of the pancreas and usually avoids loss of its endocrine and exocrine functions.^[4] In severe cases of pancreaticoduodenal^{[disambiguation needed]} injury, a pancreaticoduodenectomy can be used.^[4]^[7] Common complications after surgery include pancreatitis, pancreatic fistula, abscess, and pseudocyst formation.^[2] Initial management of hemorrhage includes controlling it by packing the wound.^[5]^[7]

History

The first recorded case of pancreatic injury was published in The Lancet in 1827.^[8] At the time, death as a result of injury was deemed to be "universal."^[8] The first successful surgery to repair a transected pancreas was performed in 1904 by Garré, who reported the case the following year.^[5]^[9]^[10]

References

^ ^a ^b ^c ^d Degiannis E, Glapa M, Loukogeorgakis SP, Smith MD (January 2008). "Management of pancreatic trauma". Injury 39 (1): 21–9. doi:10.1016/j.injury.2007.07.005. PMID 17996869. Retrieved 2012-08-04.
^ ^a ^b Brooks, A.; Shukla, A.; Beckingham, I. (2003). "Pancreatic trauma". Trauma 5: 1. doi:10.1191/1460408603ta261oa.
^ ^a ^b ^c ^d ^e Subramanian, A.; Feliciano, D. V. (2007). "Pancreatic Trauma Revisited*". European Journal of Trauma and Emergency Surgery 34: 3. doi:10.1007/s00068-007-7079-4.
^ ^a ^b ^c ^d ^e ^f ^g Boffard, Ken; Brooks, Adam (2001). "Pancreatic, splenic and duodenal injuries". In Holzheimer RG, Mannick JA. Surgical Treatment: Evidence-Based and Problem-Oriented. Munich: Zuckschwerdt. NBK6884.
^ ^a ^b ^c ^d ^e Khan MA, Cameron I (December 2010). "The management of pancreatic trauma". Journal of the Royal Army Medical Corps 156 (4): 221–7. doi:10.1136/jramc-156-04-03. PMID 21275354. |access-date= requires |url= (help)
^ American Association for the Surgery of Trauma (from Moore EE, Cogbill TH, Malangoni MA et al (1990) J Trauma 30: 1427–1429)
^ ^a ^b Stawicki SP, Schwab CW (December 2008). "Pancreatic trauma: demographics, diagnosis, and management". The American Surgeon 74 (12): 1133–45. PMID 19097525. Retrieved 2012-08-04.
^ ^a ^b Hess, Walter; Howard, John R. (2002). History of the pancreas: mysteries of a hidden organ. Kluwer Academic. pp. 363–96. ISBN 0-306-46742-9.
^ "Abstracts of Current Literature". Surgery, gynecology & obstetrics, Volume 1 (Franklin H. Martin Memorial Foundation, American College of Surgeons): 285. September 1905.
^ Demetrios Demetriades, Beat Schnüriger, and Galinos Barmparas. "49: Pancreatic injury". Surgical Management of Hepatobiliary and Pancreatic Disorders, Second Edition. ISBN 9781841847603. In 1904, Garre operated successfully on a patient with a transected pancreas.

UpToDate Contents

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1. 成人における外傷による十二指腸および膵臓損傷のマネージメント management of duodenal and pancreatic trauma in adults
2. 鈍的腹部外傷のある子供の肝臓、脾臓、および膵臓の損傷 liver spleen and pancreas injury in children with blunt abdominal trauma
3. 小児における腹部の鈍的外傷の概要 overview of blunt abdominal trauma in children
4. 外傷性後腹膜損傷の診断と初期マネージメントの概要 overview of the diagnosis and initial management of traumatic retroperitoneal injury
5. 膵体および膵体尾部病変の外科的切除 surgical resection of lesions of the body and tail of the pancreas

English Journal

Experimental acute pancreatitis is enhanced in mice with tissue nonspecific alkaline phoshatase haplodeficiency due to modulation of neutrophils and acinar cells.

Gámez-Belmonte R1, Hernández-Chirlaque C2, Sánchez de Medina F3, Martínez-Augustin O2.
Biochimica et biophysica acta. Molecular basis of disease.Biochim Biophys Acta Mol Basis Dis.2018 Nov;1864(11):3769-3779. doi: 10.1016/j.bbadis.2018.09.009. Epub 2018 Sep 11.
PMID 30251694

MiR-21-3p aggravates injury in rats with acute hemorrhagic necrotizing pancreatitis by activating TRP signaling pathway.

Wang T1, Jiang L2, Wei X1, Liu B1, Zhao J1, Xie P1, Yang B1, Wang L1.
Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie.Biomed Pharmacother.2018 Nov;107:1744-1753. doi: 10.1016/j.biopha.2018.08.164. Epub 2018 Sep 10.
PMID 30257393

Biomimetic carbon monoxide delivery based on hemoglobin vesicles ameliorates acute pancreatitis in mice via the regulation of macrophage and neutrophil activity.

Taguchi K1, Nagao S2, Maeda H2, Yanagisawa H2, Sakai H3, Yamasaki K1,4, Wakayama T5, Watanabe H2,6, Otagiri M1,4, Maruyama T2,6.
Drug delivery.Drug Deliv.2018 Nov;25(1):1266-1274. doi: 10.1080/10717544.2018.1477860.
PMID 29847178

Japanese Journal

症例 Duval手術で治癒した外傷性膵頭部主膵管損傷の1例

奈賀卓司,高屋誠吾,渡邉淨司 [他]
外科 = Surgey : 臨床雑誌 76(1), 97-100, 2014-01
NAID 40019926601

Tissue engineering による胆管再生療法の開発

合川公康,宮澤光男,岡田克也,渡邉幸博,岡本光順,小山勇
Organ Biology 21(2), 206-211, 2014
肝胆膵領域の外科手術において胆道の再建が必要となる場合には，一般的に胆管―腸吻合により胆道を再建する．しかし，この再建法においては，必ず十二指腸乳頭部(ファーター乳頭部)の逆流防止機能が廃絶されることとなり，少なからず逆行性胆管炎が起こる．さらには，長期経過において狭窄やがんの発生が報告されており，この再建法は理想的とはいえない．筆者らは，これらの問題点を考慮し，可能な限りファーター乳頭部の逆流防 …
NAID 130004715806