[Traumatic lesions of the pancreas: diagnosis and treatment]

The diagnosis and treatment of traumatic lesions of the pancreas are difficult. The deep anatomical location of the organ, the lack of truly accurate non-invasive diagnostic investigations and the frequent initial scarcity or absence of specific symptoms, often mean that a clinical assumption based on the dynamics of the trauma is fundamental for a rapid, correct diagnosis. The state of the main pancreatic duct is the most important element in establishing the prognosis and guiding the treatment, and should therefore be accurately defined before or during surgery. If the Wirsung duct is intact, even when radiological, clinical and laboratory signs indicate a pancreatic lesion, conservative treatment can be attempted. On the contrary, if there is evidence of a lesion of the duct, surgery is mandatory, bearing in mind that pancreatic resections involving removal of the portion of the gland distal to the lesion have a lower incidence of complications than do reconstructive and/or anastomotic procedures and are therefore to be preferred. Nevertheless, in selected cases, especially in young patients, Roux-en-Y pancreaticojejunostomy can avoid the risk of functional insufficiency, sparing large tracts of otherwise sacrificed glandular tissue. Only the more serious complex lesions of the head of the pancreas also affecting the duodenum require pancreaticoduodenectomy.