Diagnosis and therapy of traumatic injury of the pancreas
Ludwig, K.; Petermann, J.; Lorenz, D.
Zentralblatt für Chirurgie 123(3): 245-250
1998
ISSN/ISBN: 0044-409X PMID: 9586184 Document Number: 496617
Traumatic injuries of the pancreas are with 3 to 12% of all abdominal traumas an uncommon finding. Intraabdominal combined injuries and unspecific symptoms make an early detection often difficult. In the present study we report on 25 cases (4.7%) with pancreatic trauma out of 529 abdominal injuries that were treated between 1973 and 1996. In 68% of the cases, we detected simple gland lesions with an A.A.S.T.-score I-III (American Association for the Surgery of Trauma). In 32% of the cases, we found extended ruptures of the head of the gland (score IV and V). These patients presented severe therapeutic problems. 98% of our patients had combined intraabdominal injuries. With respect to imaging techniques, CT-scan and ERCP were the most sensitive procedures. Our therapeutic management included in 14 of the cases external drainage after debridement, 6 pancreatic head--and 3 left resections. 2 patients had to undergo a duodenopancreatectomy. The morbidity in our study was 33% (8 patients), whereas septic complications were most often encountered. The clinical mortality was 24% (6 patients). Based on our results, simple drainage after selective debridement may be sufficient for simple gland contusions. For the treatment of severe damages of the pancreatic head, including lesions of the pancreatic or bile duct or duodenum, adequate resection methods are recommended. An early diagnosis is mandatory facilitated by regular employment of CT-scanning and ERCP techniques.