Pancreatic trauma

Abstract

Injuries to the pancreas, its duct, and the pancreaticoduodenal complex frighten surgeons. Through the retropertoneal location of the pancreas means that it is not a common site of injury, it also contributes to the difficulty in diagnosis, as the organ is concealed, and often results in delay with its attendant increase in morbidity. The increase in violence in society, particularly of penetrating injuries and increase in energy of wounding from gunshot wounds, has made pancreatic injury relatively common. On the other hand, most injuries of the pancreas result from motor vehicle accidents in which the energy of the impact is directed to the upper abdomen commonly through the steering wheel. This force results in crushing of the retroperitoneal structures against the vertebral column which can lead to a spectrum of injury from conclusion to complete transection of the body of the pancreas. Mesurement of the serum amylase activity has no relation to pancreatic injury in either blunt or penetrating trauma. Computed tomography has been advocated as the best investigation for the evaluation of the pancreatic injury, while magnetic resonance cholangiopangreatography is very helpful as well. Accurate intraoperative investigation of the pancreatic duct will reduce the incidence of complications and dictate the correct operation. The management varies from simple drainage to highly challenging procedures depending on the severity and site of pancreatic injury and the integrity of the pancreatic duct.