Massachusetts Chapter of the American College of Surgeons

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Incidental Small Bowel Masses in Trauma Laparotomy: Case report and literature review of incidental small bowel ectopic pancreatic tissue
Shelbie Kirkendoll1, Reginald Alouidor2, Brianna Leung3, Katya Ford4, Annie Abraham5, Edgar Martinez Salazar6
1Valley Health System, Las Vegas, NV; 2Baystate Medical Center, Springfield, MA; 3Baystate Medical Center, Springfield, MA; 4Baystate Medical Center, Springfield, MA; 5Baystate Medical Center, Springfield, MA; 6Baystate Medical Center, Springfield, MA

Background:
Incidental findings in trauma patients are common, identified in up to 50.9% of patients in one study. There are currently no clear guidelines for management. We present here a case of an incidental small bowel mass found at trauma laparotomy.

Methods:
A 74 year old male presented with a penetrating left thoracoabdominal injury. CT abdomen/pelvis demonstrated a 3.3 cm liver laceration with active contrast extravasation. Intraoperatively, he was found to have hemoperitoneum, a grade II liver laceration with active bleeding, a 3 cm juxtacardiac left diaphragm laceration, and a left costochondral rib fracture. A pericardial window was performed and was negative. The liver and diaphragm lacerations were repaired. A 2 cm antimesenteric small bowel mass was identified at 25 cm from the ligament of Treitz. The mass was tan, irregular, and firm. We performed a small bowel wedge resection including the mass and created an anastomosis.

Results:
Our intraoperative decision to resect the incidental mass balanced multiple factors, including potential for complications, likelihood for patient follow up, risk for leaving the mass such as perforation, progression of malignancy, etc. Pathology revealed the mass and it was found to be ectopic pancreatic tissue.

Conclusion:
We propose that management of incidental findings in trauma should take into account: patient autonomy, magnitude of traumatic injuries, and the potential for operative and long term complications. Not all incidental findings warrant resection. If the mass is not resected, the findings should be communicated to the patient for follow up.


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