Pancreatic trauma with proximal duct injury

A retrospective study of patients with traumatic injuries to the head of the pancreas involving the main pancreatic duct but not the duodenum identified five cases comprising 0.5% of all abdominal, and 21% of pancreatic injuries managed operatively. Four of the injuries resulted from penetrating, and one from blunt trauma. Two patients treated with pancreaticoduodenal resection died of septic complications caused by the pancreatic procedures. Three patients undergoing duodenum-preserving pancreatic resection survived without developing diabetes during five months follow-up.

Pancreatic trauma with proximal duct injury can in some cases be managed with distal subtotal pancreatectomy. If the resection would include more than 80% of the gland, a duodenum preserving resection of the head of the pancreas with distal Roux-en-Y pancreaticojejunostomy is a viable option providing the duodenum with its vasculature, the common bile duct, and the ampulla of Vater are uninjured. Unstable patients with severe associated injuries can be managed with external drainage alone.