Vỡ rời eo tụy do chấn thương bụng ở trẻ em: Thông báo ca bệnh tại Bệnh viện Bạch Mai và tổng quan y văn=Isolated and complete traumatic rupture of the pancreas at Bach Mai Hospital: A case report and a review of the literature

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Tác giả: Ngọc Hùng Nguyễn, Trung Kiên Nguyễn, Hiếu Học Trần, Quế Sơn Trần, Thu Hương Trần

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Nghiên cứu y học (Đại học Y Hà Nội), 2024

Mô tả vật lý: tr.363-371

Bộ sưu tập: Metadata

ID: 244767

Thêm vào giỏ

Pancreatic trauma without injuries to other organs is a rare disease. The treatment depends on the systemic condition, the co-morbidity, and the integrity of the pancreatic ducts. We reported a 14-year-old man who fell in abdominal pain after hitting the handle of the ladder with his upper abdominal quadrant. The patient was admitted to our hospital 10 hours 34 minutes after the blunt trauma with stable hemodynamics and epigastric wall hematoma. The computer tomography evidence of complete rupture of the pancreatic isthmus was 32x38mm. Blood test results showed red blood cells 4.8 T/L, white blood cells 15.4 G/L, prothrombin 90.2%, amylase 130 U/L, glucose 7.02 mmol/L, GOT 41 U/L, GPT 22 U/L. The patient underwent emergency surgery with intraoperative evidence of initial necrotic-hemorrhagic pancreatitis and pancreas was ruptured grade IV (AAST). The lesion was repaired with a Roux-en-y end-to-side pancreato-jejunal anastomosis. After 4 days of surgery, the patient ate again, stayed in the hospital for 12 days, and was discharged without complications. Conclusion: the best treatment must always be individualized. Preservation due to good pancreatic parenchyma should apply to most cases, especially in children. Pancreatic duct integrity and delays in diagnosis are determinants of treatment, complications, and mortality.Vỡ tụy đơn độc do chấn thương là một bệnh lý ít gặp. Phương pháp điều trị tùy thuộc vào tình trạng toàn thân, bệnh phối hợp và tính toàn vẹn của ống tụy. Chúng tôi thông báo ca bệnh là nam, 14 tuổi vào viện sau ngã 10h34 phút do đập bụng vào ghidong xe đạp trong tình trạng huyết động ổn định, tụ máu và phản ứng thành bụng thượng vị. Chụp cắt lớp vi tính cho thấy eo tụy đụng dập tăng tỷ trọng 32x38mm, ranh giới không rõ, có điểm chảy máu. Xét nghiệm: hồng cầu 4,8 T/L, bạch cầu 15,4 G/L, prothrombin 90,2%, amylase 130 U/L, glucose 7,02 mmol/L, GOT 41 U/L, GPT 22 U/L. Người bệnh được mổ cấp cứu. Tổn thương: eo tụy vỡ độ IV, đầu tụy, thân và đuôi tụy còn lại không bị tổn thương. Xử trí: đóng đầu tụy gần, nối đầu tụy xa - hỗng tràng kiểu Roux-en-Y trên một quai ruột biệt lập. Bệnh nhân ăn lại sau mổ 4 ngày, nằm viện 12 ngày, ra viện không biến chứng. Kết luận: phương pháp điều trị tốt nhất luôn phải được cá thể hóa. Khi nhu mô tụy còn tốt, điều trị bảo tồn nên áp dụng cho phần lớn các trường hợp, đặc biệt là ở trẻ em. Tính toàn vẹn của ống tụy, chậm trễ trong chẩn đoán là những yếu tố quyết định phương pháp điều trị, biến chứng và tử vong.

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