Penetrating Trauma to the Pancreas

Abstract

Penetrating injuries to the pancreas are usually diagnosed at operation. The well-established protocols determining damage control and the management of penetrating injuries to the abdomen should be followed. When pancreatic injuries are present, the aim of the surgery is primarily to identify the extent of the parenchymal injury and the degree of duct disruption. All minor injuries and indeterminate injuries should be treated with suction drains. Resection should be reserved for injuries to the left of the PV/SMV and should include a splenectomy. Pancreaticoduodenectomy should be only performed when the injury is of such a nature that the head of the pancreas is already divided or where the injury to the duodenal ampullary complex prevents reconstruction. We recommend a two-stage resection and reconstruction. Duodenal exclusion techniques are again becoming accepted and we certainly believe in the right setting they should be used. A more conservative approach to pancreatic injuries can be justified by the increasing reports of success in treating pancreatic sequelae with endoscopic and radiological interventions. The initial treatment is usually successful in most trauma units. More advanced injuries and complications should be referred to specialized pancreatic units where experience and access to advanced endoscopy usually exist.