PANCREATIC TRAUMA WITH PROXIMAL DUCT INJURY

A retrospective study of patients with traumatic injuries to the head of the pancreas involving the main pancreatic duct but not the duodenu m identified five cases comprising 0.5 % of all abdominal, and 21 % of pancreatic injuries managed operatively. Four of the injuries resulte d from penetrating, and one from blunt trauma. Two patients treated wi th pancreaticoduodenal resection died of septic complications caused b y the pancreatic procedures. Three patients undergoing duodenum-preser ving pancreatic resection survived without developing diabetes during five months follow-up. Conclusions: Pancreatic trauma with proximal du ct injury can in some cases be managed with distal subtotal pancreatec tomy. If the resection would include more than 80 % of the gland, a du odenum preserving resection of the head of the pancreas with distal Ro ux-en-Y pantreaticojejunostomy is a viable option providing the duoden um with its vasculature, the common bile duct, and the ampulla of Vate r are uninjured. Unstable patients with severe associated injuries can be managed with external drainage alone.