Penetrating pancreatic injuries, 1978-1983

During the review period, 41 trauma service patients were found to have penetrating pancreatic injuries. The cause of injury was a gunshot wound in 25 patients, stab wound in 13 patients, and shotgun wound in 3 patients. All patients had at least one other intra-abdominal organ injured, and 19 (46%) were admitted in shock. The pancreatic injury was managed by resection in 21 patients, drainage in 19 patients, and diverticulization in 1 patient. Complications related to the pancreatic injury developed in 11 (52%) treated by resection. By comparison pancreatic complications were seen in only three (16%) patients managed with drainage (P = 0.04). The mortality rate for resection was 19 per cent compared to 11 per cent for drainage (N.S.). Differences in morbidity observed could not be clearly accounted for by severity of injury. Based on these data, the authors recommend drainage for the majority of penetrating pancreatic injuries and suggest resection be reserved for injuries requiring debridement for hemostasis.