The role of endoscopic retrograde pancreatography in the treatment of traumatic pancreatic duct injury

Background: The status of the main pancreatic duct (MPD) is the most import ant determinant of the morbidity and mortality associated with pancreatic t rauma. Early diagnosis and optimal treatment are critical, especially when there is MPD injury. Methods: Twenty-three patients with pancreatic trauma were studied prospect ively with respect to clinical and laboratory findings, CT, and endoscopic retrograde pancreatography (ERP),Treatment modalities and clinical outcome were assessed in relation to ERP findings. Results: The pancreatic duct was injured in 14 of 23 patients (11 MPD, 3 br anch duct). Contrast leakage from the MPD into peritoneal cavity at ERP con firmed MPD injury in 8 patients, who underwent surgical exploration. Three patients with leakage from a branch duct into the pancreatic parenchyma rec overed with conservative treatment. Three patients in whom ERP demonstrated contrast leakage from the MPD confined to the parenchyma underwent success ful transpapillary stent insertion with complete resolution of the leak at 3-month follow-up, Patients who underwent ERP more than 72 hours after trau ma had a significantly higher rate of pancreas-associated complications and a tendency to remain hospitalized longer than patients who underwent ERP e arlier. Conclusion: Early ERP is one of the most useful methods for demonstrating M PD injury. ERP assists with treatment planning based on the degree of pancr eatic duct injury.