Pancreatic injury remains a major source of morbidity and mortality. A previous review of this injury from our department confirmed that the failure to recognize major ductal injuries was a key element in poor outcome of these patients. We evaluated a treatment protocol in 72 consecutive patients that categorized injuries into one of four grades: grade I, pancreatic contusion or minor hematoma with an intact capsule and no parenchymal injury; grade II, parenchymal injury without major ductal injury; grade III, parenchymal disruption with presumed ductal injury; and grade IV, severe crush injury. All grade I and most grade II injuries were treated by drainage alone; the grade III and IV injuries were treated by pancreatic resection. Fifty-seven patients survived longer than 24 hours. There were 23 grade I patients. There were only minimal pancreatic complications and no deaths in this group. Of 18 patients with parenchymal injuries (grade II), only one death occurred, which was due to an inaccurate estimation of the degree of injury and delay in proper treatment. Sixteen patients with grade III and IV injuries were treated by resection with only one death, although the complications rose with increasing severity of the pancreatic injury. The mortality rate from pancreatic causes was 3% (2/57), a reduction from that in a previous report from our institution (19%). Our present study confirms the use of a vigorous diagnostic approach to pancreatic injuries, stresses the value of recognition of major ductal injury, and supports the utility of a treatment protocol in which clinical decisions are based on the severity of the pancreatic injury encountered.

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  • Corporate Authors:

    Lippincott Williams & Wilkins

    428 East Preston Street
    Baltimore, MD  United States  21202
  • Authors:
    • Smego, D R
    • Richardson, J D
    • Flint, L M
  • Publication Date: 1985-8

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Filing Info

  • Accession Number: 00453205
  • Record Type: Publication
  • Source Agency: National Highway Traffic Safety Administration
  • Report/Paper Numbers: HS-039 371
  • Files: HSL, USDOT
  • Created Date: Feb 28 1986 12:00AM