PANCREATIC INJURIES RESULTING FROM PENETRATING TRAUMA - A MULTI-INSTITUTION REVIEW

Pancreatic injury from penetrating trauma continues to be a source of significant morbidity and mortality, with questions remaining regardin g optimal treatment of injuries. Our goal was to evaluate current tren ds in the operative management of these injuries. Our patient populati on comprised all patients admitted to one of three Level I trauma cent ers over an 8-year period that had sustained penetrating pancreatic tr auma. The study was a retrospective chart review. Sixty-two patients w ere identified. All had associated abdominal injuries, with the liver and stomach being the most commonly injured organs. There were 14 deat hs (mortality 22.6%), 10 within the first 48 hours due to associated v ascular injury. In the 52 patients surviving beyond 48 hours, there we re 19 patients with injuries to the main pancreatic duct and 33 with p arenchymal injuries only. Pancreatic resection was carried out for all patients with ductal injury except for one, who later required distal pancreatectomy for pseudocyst and pancreatic fistula. Significant pan creatic fistulae developed in five patients, three in patients treated by drainage and two in patients treated by resection. The incidence o f fistula formation was significantly higher for drainage versus resec tion in the patients with ductal injuries. The incidences of other com plications were not affected by type of pancreatic injury, associated injuries, or method of management. We conclude that the majority of de aths in patients with penetrating pancreatic trauma are due to associa ted organ or vascular injuries. Appropriate management of the pancreat ic injury can reduce the long-term complications. These results suppor t treating patients with suspected ductal injuries by appropriate rese ction. Drainage should probably be sufficient for most nonductal pancr eatic injuries.