GUNSHOT INJURIES OF THE HEAD OF THE PANCREAS - CONSERVATIVE APPROACH

This study is comprised of 48 patients with gunshot injuries of the he ad of the pancreas, many of which were high velocity injuries, The pur pose of this study was to evaluate our management policy for these inj uries based on our recent wide experience. Patients with grade II and III injuries underwent conservative surgery, with 0% and 21% postopera tive mortality, respectively, directly related to the pancreatic injur y. For patients in whom the duodenum was involved, pyloric exclusion w as applied depending on the grade of the duodenal injury. We concluded that moderate gunshot injuries of the head of the pancreas (grade II) can be safely treated by debridement and suture repair, with or witho ut drainage, Severe (grade IV) injuries warrant a pancreaticoduodenect omy. Most grade III injuries can be treated by debridement and drainag e unless an associated severe duodenal injury is present, in which cas e resection may be indicated.