Treatment of pancreatic injuries.

Between 1972 and 1983 14 patients with pancreatic injuries have been treated. The diagnosis was often difficult and only made at laparotomy in most patients. Peritoneal lavage and serum amylase levels were of little help in diagnosis. Even at laparotomy, the diagnosis was initially missed in one patient. Six patients had injuries of the pancreatic head and were treated either by Whipple pancreatoduodenectomy (one patient), drainage with gastric and jejunal decompression (two patients) or simple drainage (three patients). Six patients had injuries of the pancreatic body, necessitating distal pancreatectomy and splenectomy in four cases. Two patients with contusion of the pancreatic tail were treated by drainage, followed by development of an infected pancreatic pseudocyst in one case. Six patients died (43%). It is concluded that complete inspection of the pancreas and peripancreatic hematoma is mandatory in the diagnosis and treatment of pancreatic injuries.