Management of pancreatic injuries

This is a retrospective analysis of the treatment of 18 patients with pancreatic injuries at our institution. 13 were victims of blunt abdominal trauma. 17 sustained a polytrauma and had an ISS > 15. They had 2.4 associated intraabdominal and 2.7 associated extraabdominal injuries. The mean pancreatic organ injury scale was II. A partial duodenopancreatectomy was performed in one case. In 5 cases a distal pancreatic resection was necessary. In the remaining patients drainage procedures were applied. 3 additional injured organs had to be treated during the first operation. 2 of them were situated intraabdominally. The primary operative procedure was performed in 13 cases during the first 6 hours after the trauma. 7 patients (39 %) died during the hospitalisation. None deceased during an operation. 5 patients (28 %) died because of abdominal complications. 4 of 5 patients with injuries to the great vessels died. 12 had abdominal complications. The mean hospitalisation time was 49 days. The mean drainage time was 26 days. The patients sustained parenteral nutrition for 21 days. The priority in the primary operative approach is damage control. This consists of bleeding control, control of enteral spillage, assessment of pancreatic damage, especially recognition of any ductal injury and generous drainage of the injured pancreas. Definitive treatment in the severly injured patient has to be performed after hemodynamic stabilisation without delay by an experienced surgeon.