Management of penetrating pancreatic trauma: an 11-year experience of a level-1 trauma center

Penetrating Pancreatic Injury

“…Once adequate exposure of the pancreas has been gained, management of pancreatic injury depends largely on grade and anatomic location (Table 1) [11]. Determination of the presence of ductal injury is of paramount importance and is addressed in a separate section below, BInjury to the Pancreatic Duct.^Drainage is the key element of surgical management, regardless of grade or location [10,11,13].…”

“…Determination of the presence of ductal injury is of paramount importance and is addressed in a separate section below, BInjury to the Pancreatic Duct.^Drainage is the key element of surgical management, regardless of grade or location [10,11,13]. The majority of injuries are Grade I and II injuries, which can be managed with local debridement of devitalized tissue and closed suction drainage [1, 6•, 10, 12••, 16].…”

“…This is thought to act as a seal for small pancreatic ducts not sealed by staples. Notwithstanding these many options, no particular method has been definitively proven superior to another [5,11].…”

“…Similarly, gentle saline irrigation via a 5 Fr catheter placed through the ampulla of Vater may allow injury to be recognized in the absence of fluoroscopy [22••]. Failing definitive identification of ductal injury, many surgeons recommend empiric distal pancreatectomy if suspicion of injury is high, versus external drainage accompanied by postoperative endoscopic retrograde cholangiopancreatography (ERCP) if suspicion of injury is low [11,13].…”

“…Pancreas-related complications occur in approximately one third of patients experiencing penetrating pancreatic injury [1,3,7,11]. Complications following this type of injury are largely due to either a delay in diagnosis or incomplete treatment of the injury [8•, 10, 15].…”