Diagnosis and management of pancreatic trauma

BACKGROUND: Pancreatic injury is uncommon and often presents with subtle clinical and radiological signs. For this reason, diagnosis may be delayed, or inappropriate surgery may be attempted, leading to significant morbidity and mortality. METHODS: We performed a thorough investigation of the literature between 1963 and 2008 in order to review the diagnosis and management of pancreatic trauma. RESULTS: In unstable patients and in cases of penetrating injury, immediate surgical exploration is usually essential. In these cases damage control surgery should be performed and major pancreatic resections with primary anastamoses should not be attempted, particularly in non-specialist units. In stable patients, imaging modalities are vital to grade the degree of injury and crucially identify signs of major pancreatic duct disruption, which is a key indicator of prognosis. Management may then be tailored to the degree of injury identified. CONCLUSIONS: Pancreatic injury is uncommon but must be suspected following trauma to the epigastrium. In stable patients urgent radiological investigations should be performed prior to planning treatment. Early consultation with specialist units is essential.