Pancreatic trauma: a simplified management guideline.
BACKGROUND
Recent literature supports a conservative trend in the management of pancreatic injuries. Contrary to this trend, some recommend defining ductal integrity by pancreatography, implying that the results alter management. This study examines our recent 5-year experience with a simplified approach to all pancreatic injuries.


METHODS
Retrospective analysis of patients sustaining pancreatic injuries was performed.


RESULTS
One hundred thirty-four patients were identified. Overall mortality was 13%, and pancreatic-related mortality was 2%. Analyses were based on 124 pancreatic injuries among patients who survived >12 hours. Thirty-seven proximal injuries were treated with drainage alone, with a pancreatic morbidity of 11%. Eighty-seven distal pancreatic injuries occurred, 54 with indeterminate ductal status. Twenty-four had high probability for duct injury and were treated by distal resection; 30 with a low probability of ductal injury were drained. Pancreatic morbidity was not different between these groups.


CONCLUSIONS
Pancreatic injuries including those with indeterminate ductal status can be successfully managed with low morbidity and mortality using this simplified management protocol.
Patton
J H
JH
Department of Surgery, University of Tennessee, Memphis, USA.
Lyden
S P
SP
Croce
M A
MA
Pritchard
F E
FE
Minard
G
G
Kudsk
K A
KA
Fabian
T C
TC
D000328:Adult; D000465:Algorithms; D003663:Decision Trees; D004322:Drainage; D006801:Humans; D016015:Logistic Models; D009017:Morbidity; D010179:Pancreas / Q000293:injuries*; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy