[Surgical treatment of pancreatic injuries]

Major pancreatic traumas are not frequent, and diagnosis often difficult. In a retrospective study we found 11 verified cases of pancreatic trauma treated in the period 1977-86. Three were penetrating and eight blunt trauma victims. Five patients suffered serious lesions in other organs. Laparotomy was performed in nine patients. One patient died, due to other lesions. The patients can be separated clinically into two groups. In the first group emergency laparotomy is indicated because of bleeding or peritonitis, most often due to lesions in other abdominal organs. In the other group the initial symptoms and clinical signs are sparse, and the diagnosis is based on repeated clinical examinations, ultrasound CT, peritoneal lavage and repeated amylase determinations. Contusions and minor lacerations without injury to the duct are treated with revision and canalization. Resection and pancreatico-jejunostomy should be considered when the pancreas is heavily lacerated with damage to the duct system.