Introducere: Laparoscopia diagnosticã este frecvent folositã la pacienåii hemodinamic stabili pentru identificarea leziunilor traumatice
intraabdominale, inclusiv æi ale pancreasului.
Scop: Aprecierea informativitãåii laparoscopiei diagnostice în depistarea leziunilor traumatice ale pancreasului.
Material æi metode: S-au analizat rezultatele laparoscopiei efectuate la 61 pacienåi cu traumatism abdominal închis, hemodinamic
stabili, cu leziuni confirmate ale pancreasului, trataåi în clinica de Chirurgie nr.1 ”Nicolae Anestiadi” (Institutul de Medicinã Urgentã)
timp de 14 ani. În cadrul investigaåiei s-a studiat prezenåa æi caracterul conåinutului intraabdominal cu determinarea amilazei,
prezenåa sau absenåa semnelor pancreatitei acute posttraumatice (hematoame retroperitoneale æi necroze stearinice).
Rezultate: La 24 (39,3%) pacienåi s-a depistat hemoperitoneum, ceea ce a constituit o indicaåie pentru laparotomia de urgenåã, unde
intraoperator s-au stabilit leziunile pancreasului. În 47,6% cazuri au fost stabilite semne indirecte de traumatism pancreatic: prezenåa
lichidului seros, seros-hemoragic æi bilios cu indici înalåi ai amilazei (6,6% vs 22,9% vs 3,3%). Semne directe caracteristice
pancreatitei acute posttraumatice s-au înregistrat, dupã cum urmeazã: necroze stearinice (17,2%), hematoame retroperitoneale
parapancreatice (24,1%), peritonita fermentativã (34,2%), aceæti pacienåi fiind internaåi peste 6 ore de la traumatism. În 16,4% cazuri
laparoscopia a constituit æi ca metodã curativã, fãrã necesitate de laparotomie, iar în 27,8% a completat datele examenului ultrasonografic.
Complicaåii post-laparoscopice nu au fost înregistrate.
Concluzii: Deæi poartã risc minor de complicaåii, laparoscopia depisteazã semne certe de leziune traumaticã a pancreasului doar
sub 1/3 dintre pacienåii hemodinamic stabili cu traumatism abdominal închis. În cazuri selectate poate servi ca metodã definitivã de
tratament.

Introduction: Diagnostic laparoscopy is commonly used in stable haemodynamic patients for the identification of intra-abdominal
traumatic lesions, including and pancreatic trauma.
The goal: Assessing the diagnosis informativity of laparoscopy in the detection of traumatic lesions of the pancreas.
Material and methods: The results of laparoscopy, performed on 61 patients with stable abdominal trauma, stable haemodynamics,
and confirmed pancreatic lesions treated at the Surgery Clinic no. 1 "Nicolae Anestiadi" (Institute of Emergency Medicine) for 14
years have been analysed. The presence and character of intraabdominal content with amylase determination, the presence or
absence of signs of post-traumatic acute pancreatitis (retroperitoneal hematomas and stearin necrosis) were studied.
Results: In 24 (39.3%) patients, hemoperitoneum has been detected, which was an indication for emergency laparotomy, during
which pancreas lesions were established intraoperatively. In 47.6% of cases, indirect signs of pancreatic trauma were detected:
serum, serum-hemorrhagic and bile fluid with high amylase level (6.6% vs. 22.9% vs. 3.3%). Direct signs characteristic for posttraumatic
acute pancreatitis were recorded as follows: stearin necrosis (17.2%), parapanctic retroperitoneal hematomas (24.1%),
fermentative peritonitis (34.2%), these patients being hospitalized over 6 hours from trauma. In 16.4%, laparoscopy has been also
a curative method without the need for laparotomy, and in 27.8% cases the laparoscopy completed the ultrasound examination data.
Post-laparoscopic complications have not been recorded.
Conclusions: Although laparoscopy has a minor risk of complications, it detects certain signs of traumatic lesion of the pancreas
only under one-third of haemodynamic stable patients with closed abdominal trauma. In selected cases it can serve as a definitive
treatment method.