Pancreatic injury: an audit and a practical approach

Pancreatic injuries are uncommon, difficult to diagnose and there is no uniform standard for treatment. The purpose of this study was to audit the management of pancreatic injuries in our practice. Equally important is to attempt to find out a simple management plan particularly in the era of increasing conservative treatment of injured patients. There were 22 cases of pancreatic injury. The average Glasgow coma scale of 10.9 and injury severity score of 29.1. When computed tomography is used it has a sensitivity of 33.3% which became 100% if repeated or other injuries were identified. There was one case in grade I which was treated non-operatively. There were 15 patients in grade II and they were treated by drainage. Distal pancreatectomy and splenectomy was the treatment of 3 patients with grade III injury. One patient had pancreatico-jejunostomy for grade IV injury and subsequently developed pancreatic fistula. Pancreaticoduodenectomy was the treatment of choice for two patients with grade V and both subsequently died. The over all mortality of this series was 22.7% and intra-abdominal abscesses noted in 9.1%. This series indicated that there is a need to adopt 'bail out' procedures particularly in grade IV and V pancreatic injury. A simplified management plan is suggested.