DISTAL PANCREATECTOMY FOR GUNSHOT INJURIES OF THE DISTAL PANCREAS

This study comprised 57 patients with gunshot injury of the distal pan creas. There were 16 grade 11, 29 grade III and 12 grade IV pancreatic injuries. The intraoperative mortality rate was 12 per cent. Patients with the most severe grade II injuries and all those with grade III a nd IV injuries had distal pancreatectomy and splenectomy, with a 14 pe r cent fistula formation rate and 2.3 per cent postoperative mortality rate directly related to the pancreatic injury. The remaining patient s with grade II injuries were managed by debridement and drainage; the re were no fistulas or deaths. The method of closure of the pancreatic resection margin is unrelated to fistula formation, and identificatio n of the duct for ligation is unnecessary. Liberal use of distal pancr eatectomy a with splenectomy for gunshot injuries of the distal pancre as is suggested.