[Traumatic disease of the pancreas]

Authors report their own experience referring to 12 pancreas traumatic lesions and they analyse the most updated and controversial aspects of such pathology. Concerning clinical detection, in spite of better chances of diagnosis given by computed tomography, delays and diagnostic difficulties are still considerable, both pre-operatory especially in isolated closed traumas, and during laparotomy for the detection of the lesion and check-up of a possible wirsung section. In most cases pancreatic lesions are of lesser degree, belonging to the I and II stage according Lucas' classification and can be treated with an external drainage performance. We have no choice but such conservative approach in the more serious cases, whenever a ductal lesion exists, if the patient suffers from hemodynamic lability and it is worth reducing the time of the operation and hematic losses or in those cases where serious associated lesions exist which require a priority treatment. While body and tail lesions can be successfully treated with distal pancreasectomy technique, in serious cephalic traumas there is a limited experience and it doesn't exist a common view on the matter. In these cases we believe to be useful to perform resections only as the last chance, since we prefer to perform alternative operation such ad internal drainage on jejunal ansa or pylorus exclusion. This last operation seems to achieve better results in terms of morbidity and mortality.