Management of pancreatic injuries

This is a retrospective analysis of the treatment of 18 patients with pancr eatic injuries at our institution. 13 were victims of blunt abdominal traum a. 17 sustained a polytrauma and had an ISS > 15. They had 2.4 associated i ntraabdominal and 2.7 associated extraabdominal injuries. The mean pancreat ic organ injury scale was II. A partial duodenopancreatectomy was performed in one case. In 5 cases a distal pancreatic resection was necessary. In th e remaining patients drainage procedures were applied. 3 additional injured organs had to be treated during the first operation. 2 of them were situat ed intraabdominally. The primary operative procedure was performed in 13 ca ses during the first 6 hours after the trauma. 7 patients (39%) died during the hospitalisation. None deceased during an operation. 5 patients (28%) d ied because of abdominal complications. 4 of 5 patients with injuries to th e great vessels died. 12 had abdominal complications. The mean hospitalisat ion time was 49 days. The mean drainage time was 26 days. The patients sust ained parenteral nutrition for 21 days. The priority in the primary operati ve approach is damage control. This consists of bleeding control, control o f enteral spillage, assessment of pancreatic damage, especially recognition of any ductal injury and generous drainage of the injured pancreas. Defini tive treatment in the severly injured patient has to be performed after hem odynamic stabilisation without delay by an experienced surgeon.