Diagnosis and treatment of pancreatic injuries. An analysis of management principles
D. H. Wisner, R. L. Wold and C. F. Frey
Department of Surgery, University of California, Davis, Sacramento 95817.
Ninety-one pancreatic injuries, 47 from blunt trauma, were reviewed with
respect to management principles stressed in qi previous reviews. The
pancreatic complication rate was 25%. Blunt injury was suspected
preoperatively in only 30%. Even short-term observation led to morbidity.
Operations done more than 6 hours after admission had a higher complication
rate (45%) than those done less than 6 hours after admission (18%). Penrose
drainage without a sump was not associated with increased complications.
Distal pancreatectomy was done 32 times; splenectomy was done in only 18
patients. Individual duct ligation was rarely done and did not result in a
high fistula rate. Pancreatic stump oversew with nonabsorbable suture was
associated with a higher rate of pancreatic complications than absorbable
suture (58% vs 30%). Only 56% of patients receiving distal pancreatectomy
required hyperalimentation. Postoperative serum amylase values were not
useful, and amylase values from drainage fluid predicted complications only
when they were above 100,000 U/L. Details of pancreatic trauma management
are less important than early operation in minimizing morbidity.
