Management of pancreatic trauma: concepts and controversy

Four cases of pancreatic trauma are critiqued, and an algorithm to guide management is outlined. The key to operative assessment of pancreatic injury is the presence or absence of major ductal disruption. The surgeon's assessment is usually accurate, but when doubt exists, intraoperative pancreatography is advocated. In patients with significant pancreatic head injury with ductal disruption and associated duodenal injury, pancreaticoduodenectomy is recommended. In spite of reports to the contrary, duodenal diverticulization should be reserved for the patient with a repairable duodenal injury in association with a pancreatic head wound without ductal disruption.