Diagnosis and treatment of pancreatic injuries. An analysis of management principles.
Ninety-one pancreatic injuries, 47 from blunt trauma, were reviewed with respect to management principles stressed in qi previous reviews. The pancreatic complication rate was 25%. Blunt injury was suspected preoperatively in only 30%. Even short-term observation led to morbidity. Operations done more than 6 hours after admission had a higher complication rate (45%) than those done less than 6 hours after admission (18%). Penrose drainage without a sump was not associated with increased complications. Distal pancreatectomy was done 32 times; splenectomy was done in only 18 patients. Individual duct ligation was rarely done and did not result in a high fistula rate. Pancreatic stump oversew with nonabsorbable suture was associated with a higher rate of pancreatic complications than absorbable suture (58% vs 30%). Only 56% of patients receiving distal pancreatectomy required hyperalimentation. Postoperative serum amylase values were not useful, and amylase values from drainage fluid predicted complications only when they were above 100,000 U/L. Details of pancreatic trauma management are less important than early operation in minimizing morbidity.
Wisner
D H
DH
Department of Surgery, University of California, Davis, Sacramento 95817.
Wold
R L
RL
Frey
C F
CF
D000328:Adult; D000681:Amylases / Q000097:blood; D004322:Drainage / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000401:mortality / Q000601:surgery
D000681:Amylases