Operative strategies in pancreatic trauma - keep it safe and simple

Injuries to the pancreas are infrequently encountered in surgical practice but may result in substantial morbidity and mortality if pancreatic, visceral vascular and adjacent organ injuries occur in combination. Recent data indicate a rising incidence of pancreatic trauma owing to high-speed car accidents and an escalation in civil violence involving increasingly dangerous weapons. In South African and North American cities, penetrating abdominal injuries from gunshot wounds are the most common cause of pancreatic trauma, while in Western Europe, England and Australia, traffic accidents predominate. The mechanism of injury dictates intervention. After penetrating injuries, the diagnosis is usually established at laparotomy, while in those who have sustained blunt polytrauma, pancreatic injuries are generally detected by radiological investigations, allowing some patients to be managed without recourse to surgery. This geographical variation in aetiology and the difference in investigative approach results in considerable disparity in the reported severity and spectrum of pancreatic injuries.