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Vol. 125 No. 12, December 1990 |
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PAPERS READ BEFORE THE 14TH ANNUAL SURGICAL SYMPOSIUM OF THE ASSOCIATION OF VETERANS AFFAIRS SURGEONS, CHARLESTON, SC, MAY 7 TO 9, 1990 |
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Reappraisal of Pancreatic and Duodenal Injury Management Based on Injury Severity
William J. Flynn, Jr, MD;
H. Gill Cryer, MD, PhD;
J. David Richardson, MD
Arch Surg. 1990;125(12):1539-1541.
Abstract
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• We evaluated the effectiveness of treatment protocols for pancreatic and duodenal injuries according to the severity of injury. Of 81 patients, 65 survived initial injury. Pancreatic injuries without ductal involvement occurred in 21 patients and were treated by drainage. No late deaths occurred. Pancreatic injuries with ductal disruption occurred in 18 patients and were treated by pancreatic resection. Abscesses developed in seven (39%) of the patients, but no late deaths occurred. Nineteen patients had duodenal injuries without pancreatic injury, and no duodenal complications occurred. Simple closure sufficed for injuries affecting up to 40% of the duodenal circumference. Wounds affecting up to 40% of the duodenal circumference can be treated by suture closure alone. Adjunctive duodenal tube decompression should be reserved for wounds affecting greater than 40% of the duodenal circumference, closure under tension, and associated injuries to the head of the pancreas. Pyloric exclusion was rarely necessary in our patients.
(Arch Surg. 1990;125:1539-1541)
Author Affiliations
From the Department of Surgery, University of Louisville School of Medicine, and the Trauma Program in Surgery, Humana Hospital University, Louisville, Ky.
Footnotes
Accepted for publication July 21, 1990.
Read before the 14th Annual Surgical Symposium of the Association of Veterans Affairs Surgeons, Charleston, SC, May 7, 1990.
Reprint requests to Department of Surgery, University of Louisville School of Medicine, Louisville, KY 40292 (Dr Richardson).
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