Management of Pancreatic Trauma

Traumatic abdominal injuries involving the pancreas account for ~3–5% of abdominal injuries but are associated with high morbidity and mortality. Contributing factors to poor outcomes are subtle presentations lacking egregious signs of injury and retroperitoneal location of the pancreas, resulting in difficulty in identification of pancreatic injury on physical exam and diagnostic imaging. Once the source of injury has been identified, with the junction of the pancreatic body and tail commonly deemed the culprit, it is of paramount importance to determine the integrity of the pancreatic duct as it can dictate treatment course. Pancreatic injuries can be graded from I to V (AAST-OIS), with Grades I–II indicating hematoma with no tissue loss and preservation of pancreatic duct. Grade III involves laceration and distal transection, while Grades IV–V involve major parenchymal injury and proximal ductal transection. Operative strategies revolve around bleeding control, selective debridement, and preservation vs. resection of pancreatic tissue.