Factors affecting outcome in pancreatic trauma.

Reported mortality from pancreatic trauma remains at approximately 20% and morbidity is about 33%. A recent series was reviewed to highlight unresolved problems associated with this injury. From 54 consecutive patients treated operatively for pancreatic trauma during a recent 7-year period, 44 patients were evaluated. Among these 44, six died and 12 developed fistulas and/or abscesses. Of those who died, four had colon injuries and two had duodenal injuries, one of whom had combined colon and duodenal injuries. Patients with colon injuries also had a higher incidence of intra-abdominal abscesses and fistulas. Indeed, colon injury currently may be the most significant factor causing morbidity and mortality in cases of pancreatic trauma. Despite improved management of duodenal injuries, morbidity and mortality rates for these patients also remain high. Twenty-six patients went into shock before the end of their operation, and all six deaths occurred in this group. The mean number of intra-abdominal associated organ injuries was 2.1 per patient; complications and deaths were directly related to these injuries.