OPERATIVE STRATEGIES IN PANCREATIC TRAUMA

Pancreatic injuries are relatively uncommon and the choice of an appro priate operative procedure can be difficult. Operations for pancreatic trauma from January 1990 to June 1993 have been reviewed. Fifty-one p atients were studied; 13 had blunt trauma, 17 gunshot wounds and 21 st ab wounds. The distribution of injuries was: pancreatic head (17), bod y (15) and tail (19). Most patients had associated injuries of surroun ding organs. Operations performed included pancreatoduodenectomy (seve n), distal pancreatectomy (seven) and external drainage (35). Five pat ients (10 per cent) died: two from haemorrhage, one from an acute subd ural haematoma and two from multiple organ failure, Ten patients (20 p er cent) developed a pancreatic fistula, four following blunt trauma, four after gunshot wounds and two with stab wounds; all but one had un dergone drainage procedures. Stab wounds were associated with a low in cidence of duct injury and external drainage was usually satisfactory, After blunt trauma and gunshot wounds, duct injuries were common and easily missed; careful exploration by an experienced surgeon is essent ial. In appropriately selected patients, pancreatic resection can be p erformed with good result.