Penetrating pancreatic injuries. Analysis of 103 consecutive cases

The optimal management of penetrating pancreatic injuries continues to be a matter of debate and controversy. The present study analyzes 103 consecutive patients with these wounds treated at a level I Trauma Center in a 14-year period (1975-1988). Twenty-seven patients died within 48 hours from exte...

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Bibliographic Details
Published inThe American surgeon Vol. 56; no. 2; p. 90
Main Authors Ivatury, R R, Nallathambi, M, Rao, P, Stahl, W M
Format Journal Article
LanguageEnglish
Published United States 01.02.1990
Subjects
Adolescent
Adult
Female
Humans
Male
Methods
Middle Aged
Pancreas - injuries
Pancreas - surgery
Postoperative Complications
Retrospective Studies
Wounds, Penetrating - complications
Wounds, Penetrating - surgery
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Summary:The optimal management of penetrating pancreatic injuries continues to be a matter of debate and controversy. The present study analyzes 103 consecutive patients with these wounds treated at a level I Trauma Center in a 14-year period (1975-1988). Twenty-seven patients died within 48 hours from extensive associated trauma (Abdominal Trauma Index [ATI] 46.7). The majority of the remaining 76 patients were treated by debridement and drainage. Nineteen patients with grade III injuries had distal pancreatectomy. Six patients with extensive combined pancreatoduodenal injuries had pancreatoduodenectomy. Pancreatoenteric anastomoses or duodenal diversion procedures rarely were used. Pancreatic complications included major fistulas in four patients (5%) and pancreatic abscess in nine patients (11%). Only one of the fistulas required subsequent fistulojejunostomy. Intra-abdominal abscesses occurred in 18 patients (23.6%), mostly in patients with associated colon injury (P less than 0.001). It is concluded that a conservative approach to penetrating pancreatic injuries yields optimal results and that associated colon injury is an important predeterminant for abscess formation.
ISSN:0003-1348