title: Management of pancreatic trauma and its consequences--guidelines or individual therapy?
abstract: OBJECTIVE
  Diagnosis of pancreatic trauma and its complications may be difficult due to non-specific signs and symptoms and treatment recommendations are not unequivocal.
  
  
  METHODS
  Clinical data of a series of 47 patients with pancreatic trauma were analyzed; most of them were polytraumatized and treated by an interdisciplinary team.
  
  
  RESULTS
  The most common causes were traffic accidents and sport injuries with 66% and 15%, respectively. Concomitant injuries were seen in 96% (nonpancreatic intra-abdominal injuries 85% including spleen 38% and liver 34%, extra-abdominal injuries 70%). Concomitant liver injuries were treated conservatively in 31% and operatively in 69% (including hepatic packing in 38%). Concomitant splenic injuries were usually very severe and could be managed conservatively in only 11%. All patients with pancreatic injuries grade III, IV or V (17%) according to the American Association of Surgical Trauma Classification required surgery, endoscopic treatment or interventional radiology. The most common posttraumatic complications were necrotizing pancreatitis (15%), pseudocyst formation (9%), abscesses (6%) and fistulas (4%).
  
  
  CONCLUSIONS
  The status of the pancreatic duct is the crucial point for management of pancreatic trauma and should be assessed as early as possible. Treatment has to be tailored to the individual situation, especially in patients with severe concomitant injuries or prolonged course.
authors.affiliation: Department of Visceral Surgery, Medical University of Graz, Austria. herwig.cerwenka@meduni-graz.at
authors.forename: H
authors.initials: H
authors.lastname: Cerwenka
authors.forename: H
authors.initials: H
authors.lastname: Bacher
authors.forename: A
authors.initials: A
authors.lastname: El-Shabrawi
authors.forename: P
authors.initials: P
authors.lastname: Kornprat
authors.forename: M
authors.initials: M
authors.lastname: Lemmerer
authors.forename: H R
authors.initials: HR
authors.lastname: Portugaller
authors.forename: H J
authors.initials: HJ
authors.lastname: Mischinger
mesh_terms: D018784:Abdominal Abscess / Q000209:etiology; D000007:Abdominal Injuries / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D009104:Multiple Trauma / Q000175:diagnosis / Q000601:surgery*; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010182:Pancreatic Diseases / Q000209:etiology*; D010183:Pancreatic Ducts / Q000293:injuries* / Q000601:surgery; D010185:Pancreatic Fistula / Q000209:etiology; D010192:Pancreatic Pseudocyst / Q000209:etiology; D019283:Pancreatitis, Acute Necrotizing / Q000209:etiology; D010348:Patient Care Team; D011183:Postoperative Complications / Q000209:etiology*; D017410:Practice Guidelines as Topic; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*