Combined pancreatoduodenal injuries

Operative management of combined pancreatic and duodenal injuries has been a controversial subject in recent years. Methods advocated include resection, duodenal diversion, and simple repair and drainage. Excellent results have been reported with each of these, but most reported series are small, preventing definitive conclusions concerning the value of any treatment modality. During an 8-year period ending December 1976, 308 pancreatic injuries and 175 duodenal injuries were treated. Sixty-eight of the patients had combined pancreatic and duodenal injuries and constitute the basis for this report. Fifty-five patients sustained penetrating injuries and 13 had blunt injuries. Eighteen underwent repair and drainage. The remaining 50 required more extensive procedures which included duodenal diversion and pyloric exclusion in 32, pancreatoduodenectomy in six, and a variety of procedures in the remainder. The operative mortality rate was 26.4%, including five patients who died intraoperatively. In the entire series only one death was directly attributable to the pancreatoduodenal injury. We conclude that no single procedure is uniformly applicable to these injuries. Surgeons treating trauma of this severity should be familiar with a variety of techniques for repair, and treatment should be individualized. Preservation of tissue should be accomplished when possible.