Pancreatic injury in severe trauma: early diagnosis and therapy improve the outcome.
BACKGROUND
Pancreatic injury is a dangerous complication in multiple injury, and experience with its diagnosis and treatment is usually limited.


METHODS
Retrospective analysis of 3,840 patients admitted after multiple trauma from January 1, 1982, until May 31, 2000.


RESULTS
A laparotomy was performed in 121 cases (3.15%) due to suspected intra-abdominal lesion. 32% of the patients (39/121) had a pancreatic lesion; 23% (9/39) had a rupture of the major pancreatic duct. Primary laparotomy was performed in 72% of the patients (28/39). Superficial lesions were treated by explorative laparotomy alone (n = 7), debridement and external drainage (n = 20), or necrosectomy and lavage (n = 3). Complex pancreatic lesions were treated by pancreatojejunostomies (n = 5), pancreatic left resections (n = 2), or exploration alone (n = 2). 8 of 39 patients died (20%), 4 intraoperatively. Of the surviving 35 patients, a pancreas-associated complication developed in 8 patients (23%): pancreatic abscesses (n = 4), traumatic pancreatitis (n = 3), pancreatic fistulas (n = 2), and pseudocysts (n = 2).


CONCLUSIONS
Pancreatic injury is an infrequent but dangerous complication in severe trauma. Superficial lesions not affecting the major pancreatic duct can be managed by debridement and external drainage. If the major pancreatic duct is ruptured, organ-preserving, complex reconstructive procedures are necessary. When diagnosed timely and treated according to severity and overall situation, pancreatic injuries have an acceptable morbidity, but usually a high mortality.
Department of General Surgery, University Hospital, Ulm, Germany.
Jens M
JM
Mayer
Reinhold
R
Tomczak
Bettina
B
Rau
Florian
F
Gebhard
Hans G
HG
Beger
D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D022125:Lacerations; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000401:mortality / Q000601:surgery*; D010179:Pancreas / Q000000981:diagnostic imaging / Q000293:injuries*; D010180:Pancreatectomy; D010183:Pancreatic Ducts / Q000293:injuries; D012189:Retrospective Studies; D012421:Rupture; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome