Features of diagnosing battlefield pancreatic injuries during the war in Ukraine

Background The diagnosis of battlefield pancreatic injury (BPI) has specific features related to the stages of care and remains one of the most complex and resource-intensive problems in medical care. Methods Retrospective analyses of 1345 medical records of military personnel and civilian patients with battlefield abdominal injuries were performed. Biochemical blood analysis with determination of serum alpha-amylase, focused assessment with sonography in trauma (FAST), abdominal X-ray, multispiral computed tomography (MSCT) of the abdominal and pelvic organs, endoscopic retrograde cholangiopancreatography, intraoperative ultrasonography, indocyanine green fluorescent angiography and intraoperative revision of the pancreato‒duodenal complex were used. Results BPI was diagnosed in 117 (8.7%) patients. A total of 90 patients were included. Gunshot shrapnel pancreatic wounds were diagnosed in 81.1% of patients. Injury to the head of the pancreas was diagnosed in 18.9% of the patients, to the neck in 1.1%, to the body in 14.4%, and to the tail in 55.6%. Multiple injuries were detected in 10% of the patients. Intraoperative revision of the pancreato‒duodenal complex in hemodynamically unstable patients diagnosed with BPI in 78.2% of patients. BPI diagnosis in 85.7% of hemodynamically stable patients was based on preoperative serum alpha-amylase, FAST, and intraoperative X-ray. At the hospital stage of medical care, the sensitivity of the extended BPI diagnostic algorithm was 98.8%. Conclusions BPI diagnosis is difficult because of its rarity, anatomical and topographical features of the pancreas, polysymptomatic clinical presentation in combined and multiple injuries, manifestations of traumatic and hypovolemic shock, and peritonitis. The main examination methods for BPI are MSCT of the abdominal cavity and pelvis and detailed intraoperative revision of the pancreato‒duodenal complex. Trial registration Not applicable. This retrospective study did not require trial registration.