Dynamics of the Ultrasound Indexes Changes of Pancreas during Mechanical Trauma

In case of mechanical trauma of parenchymal abdominal organs the number of damage to the pancreas according to various data is 1.5 to 9% and is characterized by high mortality from 12% to 42% due to the absence of clinical symptoms. Therefore, there are difficulties in diagnosing. With the aim to solve the problem of pancreatic trauma diagnosis number of laboratory methods usually are used: laparoscopic, biochemical, biophysical, ultrasound diagnostics, and others. The ultrasound diagnostic method is reasonable and reliable for establishing the limitation of the pancreas damage occurrence in case of mechanical injury. The purpose of research is to study the dynamic changes of pancreas ultrasound parameters at various types of mechanical injury, depending on the period of injury. Materials and methods. Ultrasound diagnosis using ultrasound frequency from 0.5 to 1.5 million vehicles fluctuations on Sonoace 8000 (South Korea), Sonosite Titan (USA) was performed to detect pathological changes in organs and tissues. 28 injured were examined. Examination of the abdomen and retroperitoneal area was conducted as well as the dynamics of 1, 2, 3 and 5 days after injury. Results and discussion. According to collected data, when establishing this type of injury, knowledge of the mechanism of injury, laboratory blood and urine tests helps with the maintenance of a laparoscopy of the abdominal cavity and retroperitoneum, ultrasound of the internal organs of the abdominal cavity. Clinical and ultrasound diagnosis of pancreatic injury is quite complicated in all cases of mechanical injury. Isolated pancreatic damage was observed in 5 patients (18%), of which 3 males and 2 females, in the other 23 suffered (82%), of which 17 males and 5 females, pancreatic injury was combined with liver damage, gall bladder and extrahepatic bile duct, spleen, intestine. Ultrasound examination was complicated by the presence of intestinal hyperpneumatosis in the development of dynamic bowel obstruction and diffuses peritonitis. In 28 victims (18 males and 10 females) in the first 6 hours a lack of clear contours of the gland, their discontinuity, an increase in the size of the gland in 1,5-2 times, a change in the nature of echogenicity due to the appearance of hypoechoic regions of different sizes were observed. With complete crushed glands in its projection, the unstructured mass was determined with the presence of peri-penetrating fluid infiltration. The peri-pancreatic fluid, which was observed in 6 cases in the first hours after the injury, had the appearance of hypo- and anechoic formations in the projection of a stuffing box bag. In the affected pancreas, there was no clear boundary and form; more or less infiltration was formed in the retroperitoneal cellular tissue. Conclusions. Thus, it was found out that natural dynamics of changes in the ultrasound parameters of the pancreas in the injured and died as a result of the injuries, indicate the possibility of developing a set of criteria for assessing the establishment of the limitation of the occurrence of damage to the internal organs of the retroperitoneal space, in particular, the pancreas. It has been established that clinical and ultrasound diagnostics in all cases of mechanical injury with pancreas damage was quite complicated. Characteristic ultrasound criteria for pancreas damage in the first day was the absence of clear contours of the gland, their discontinuity, the increase in the size of the gland, the presence of hypoechoic regions of various sizes. In cases of complete degeneration of the gland in its projection, a nonstructural mass with peripanecrotic fluid infiltration, which had the appearance of hypo- and anechoic formations with fuzzy contours in the projection of a stuffing bag, was determined.