Treatment of pancreatic injuries. Study of a series of 34 patients
Reith, H.B.; Dittrich, H.; Kozuschek, W.
Journal de Chirurgie 130(5): 247-251
1993
ISSN/ISBN: 0021-7697 PMID: 8102145 Document Number: 413022
Routine retrograde imaging of Wirsung's duct, an essential investigation of pancreatic injuries, should be carried out preoperatively and, in case of failure of the intervention, intraoperatively. Whereas simple drainage is sufficient treatment for injuries to the pancreatic parenchyma, lesions of Wirsung's duct require either duodeno-cephalic pancreatectomy or left pancreatic resection, depending on the site of the ductal wound, conservative treatment carrying the major risk of a post-traumatic acute pancreatitis with its particularly elevated mortality rate. Of the 34 cases, reported: 24 (70.6%) were treated by resection: 3 by duodenocephalic pancreatectomy and 21 by left pancreas resection, 6 (17.6%) by suture of the parenchyma and contact drainage and 4 (11.8%) by drainage of Wirsung's duct by catheter or excluded loop in Y. Mortality was 14.7% (5 of the 34 patients). Complications included pseudocysts requiring operative removal in 3 of the 6 patients treated by suture-drainage, and severe sepsis in 5 patients with a fatal outcome in 3 cases. Treatment was unsuccessful in 2 of the 4 patients treated by drainage by catheter or excluded loop in Y, whereas mortality was nil after pancreatic resection.