Changing trends in the management of pancreatic trauma

Forty-four patients were operated on for pancreatic trauma during the past three years. Twenty-one patients (48%) were treated by drainage alone, nine (21%) by distal resection, eight (19%) by duodenal diversion, and one (2%) by pancreatoduodenectomy. Active sump drainage was used in 27 patients (71%) and early enteral feeding by needle catheter jejunostomy in 24 (63%) postoperatively. Of the 38 patients who survived the initial operation, two (5%) died postoperatively. Pancreas-related complications occurred in 13 patients (34%). Comparison with earlier findings from our institution reveals (1) more frequent use of active sump drainage, (2) continued use of distal resection for suspected ductal injuries of the body or tail, (3) earlier postoperative nutrition by needle catheter jejunostomy, and (4) increased use of duodenal diversion for concurrent pancreatic and duodenal trauma.