Contribution of endoscopic retrograde pancreatography in management of complications following distal pancreatic trauma.

Pancreatic trauma is associated with high morbidity and mortality. Treatment of this condition is controversial. This retrospective study aimed to evaluate the management of distal pancreatic trauma and its complications, assessing the role of endoscopic retrograde cholangiopancreatography (ERCP). The clinical course and surgical management of 38 patients with distal pancreatic trauma were analyzed in a university hospital in Paris, France. Twenty-five patients were referred after initial treatment elsewhere. As initial treatment, patients underwent external drainage (n = 25), pancreatic resection (n = 6), laparotomy alone (n = 5), and no surgery (n = 2). Nineteen patients with pancreatic duct injury and no pancreatic resection developed fistulae (n = 14) or pseudocysts (n = 5). Only four of these patients recovered without a subsequent pancreatic resection or internal drainage procedure. In the absence of duct injury, patients recovered without the need for pancreatic resection. ERCP was performed in 16 cases and provided critical information on duct status influencing surgical management. We conclude that the presence of pancreatic trauma duct injury is a major determinant of complications and outcome after pancreatic trauma. It is optimally managed by pancreatic resection. ERCP is valuable in providing a definitive diagnosis of duct injury, thereby directing treatment.