Management of pancreatic trauma

The majority of patients who sustain penetrating blunt trauma to the pancreas can be managed with sump drainage, including those with gunshot wounds to the head of the pancreas. Pancreatico-duodenectomy may be indicated in 2 to 3 percent of cases of pancreatic injury. Patients who require resection of 80 percent or more of the pancreas and do not have splenic injury should be considered for a Roux-Y anastomosis to the distal pancreas after ductal injury has been proved. Severe injuries to the body of the pancreas are best managed by distal pancreatectomy. The mortality rate due to pancreatic injury has been less than 3 percent and rarely is the cause of death. To support this conclusion, few normotensive patients die, and no patient with an isolated pancreatic injury in our series died. The severity of injury often dictates the appropriate treatment. A conservative approach is indicated for most pancreatic injuries, resulting in shorter operating time and less blood loss in the unstable patient with multiple injuries. Most important is identification of ductal injury at the initial operation and institution of surgical drainage.