Management of pancreatic and duodenal trauma

Eighty-four patients were treated for pancreatic or duodenal injuries or both over a 13 year period. Isolated contusion of the duodenum was managed by drainage only, and disruption was managed with primary closure, coverage of the closure with a serosal patch, and drainage. Patients with distal pancreatic injuries that involved the body or tail of the pancreas and were total or near-total transections underwent distal pancreatectomy and splenectomy. The difficult areas of management continue to be the type III and IV pancreatic and duodenal injuries. Extensive pancreatic resection should be reserved for those situations in which the pancreas has been devitalized and it is not expected that resolution will occur with drainage. The mortality in combined severe pancreatic and duodenal injuries was 64 percent with death related to associated injuries in most cases; however, extensive resection (Whipple procedure) in two cases led to death because of leakage from the anastomosis with subsequent retroperitoneal infection. Postoperative management of patients with pancreatic and duodenal injuries should always include careful attention to nutrition.