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Table 6 Duodeno-pancreatic and extra-hepatic biliary tree lesions

From: Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Grade WSES class Organ AAST Description of injury
Minor WSES class I Pancreas I–II - Minor contusion without duct injury
Superficial laceration without duct injury
- Major contusion without duct injury or tissue loss
Major laceration without duct injury or tissue loss
Duodenum I - Hematoma involving a single portion of duodenum
Laceration: partial thickness, no perforation
Extrahepatic biliary three I–II–III - Gallbladder contusion/hematoma. Portal triad contusion
- Partial gallbladder avulsion from liver bed; cystic duct intact. Laceration or perforation of the gallbladder
- Complete gallbladder avulsion from liver bed. Cystic duct laceration
Moderate WSES class II Pancreas III - Distal transection or parenchymal injury with duct injury
Duodenum II - Hematoma involving more than one portion
Laceration with disruption of less than 50% of circumference
Extrahepatic biliary three IV Partial or complete right hepatic duct laceration
Partial or complete left hepatic duct laceration
Partial common hepatic duct laceration (< 50%)
Partial common bile duct laceration (< 50%)
Severe WSES class III Pancreas IV–V - Proximal transection or parenchymal injury involving ampulla
- Massive disruption of pancreatic head
Duodenum III–IV–V - Disruption 50–75% of circumference of D2
Disruption 50–100% of circumference of D1, D3, and D4
- Disruption > 75% of circumference of D2 involving ampulla or distal common bile duct
- Massive disruption of duodeno-pancreatic complex
Devascularization of duodenum
Extrahepatic biliary three V > 50% transection of common hepatic duct
> 50% transection of common bile duct
Combined right and left hepatic duct injuries
Intraduodenal or intrapancreatic bile duct injuries
WSES class IV Any Any Any degree of lesion with hemodynamic instability