title: Management of pancreatic trauma: A pancreatic surgeon's point of view.
abstract: BACKGROUND
  Pancreatic trauma occurs in 0.2% of patients with blunt trauma and 1-12% of patients with penetrating trauma. Traumatic pancreatic injuries are characterised by high morbidity and mortality, which further increase with delayed diagnoses. The diagnosis of pancreatic trauma is challenging. Signs and symptoms can be non-specific or even absent.
  
  
  METHODS
  A critical review of studies reporting the management and outcomes of pancreatic trauma was performed.
  
  
  RESULTS
  The management of pancreatic trauma depends on the haemodynamic stability of the patient, the degree and location of parenchymal injury, the integrity of the main pancreatic duct, and the associated injuries to other organs. Nevertheless, the involvement of the main pancreatic duct is the most important predictive factor of the outcome. The majority of pancreatic traumas are managed by medical treatment (parenteral nutrition, antibiotic therapy and somatostatin analogues), haemostasis, debridement of devitalised tissue and closed external drainage. If a proximal duct injury is diagnosed, endoscopic transpapillary stent insertion can be a viable option, while surgical resection by pancreaticoduodenectomy is restricted to an extremely small number of selected cases. Injuries of the distal parenchyma or distal duct may be managed with distal pancreatectomy with spleen preservation. At the pancreatic neck, when pancreatic transection occurs without damage to the parenchyma, a parenchyma-sparing procedure is feasible.
  
  
  CONCLUSIONS
  The management of pancreatic injuries is complex and often requires a multidisciplinary approach. Here, we propose a management algorithm that is based on parenchymal damage and the site of duct injury.
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy. Electronic address: Calogero.Iacono@univr.it.
authors.forename: Calogero
authors.initials: C
authors.lastname: Iacono
authors.affiliation: Department of Radiology, University of Verona Medical School, Verona, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Zicari
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Conci
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Valdegamberi
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: De Angelis
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Pedrazzani
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Ruzzenente
authors.affiliation: Department of Surgery, Division of General Surgery, Unit of Hepato-Pancreato-Biliary Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Guglielmi
mesh_terms: D000465:Algorithms; D000066491:Clinical Decision-Making; D004322:Drainage; D006801:Humans; D010179:Pancreas / Q000293:injuries* / Q000601:surgery; D010180:Pancreatectomy; D016577:Pancreaticoduodenectomy; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000601:surgery*
keywords: Abdominal trauma; Management of pancreatic trauma; Pancreatic injuries; Pancreatic trauma; Parenchyma-sparing pancreatic procedures; Traumatic pancreatic transection