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Blunt Pancreatoduodenal Injury—Invited Critique
John E. Sutton Jr, MD
Arch Surg. 2009;144(5):419-420.
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Blunt pancreatoduodenal injury has historically challenged surgeons because of the difficulty of establishing a correct early diagnosis and the fear that a missed injury will lead to increased morbidity and mortality. The fact that severe BPI is rare makes it difficult to establish evidenced-based algorithms, since no single institution is likely to have an extensive experience with the management of such injuries. Indeed, many of the current treatment recommendations such as drainage for minor injuries, ERCP to establish ductal integrity, and distal pancreatectomy for more severe injuries have seldom been tested against other management strategies.
This large regional multicenter study examines the outcomes for nonoperative management of BPDI as well as the sensitivity of the CT scan used in determining the diagnosis. The authors caution that the sensitivity of newer generation CT scans still remains in the range of 80%. However, one could question whether . . . [Full Text of this Article]
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Arch Surg. 2009;144(5):413-419.
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