Abstract
BackgroundPancreatic trauma management hinges upon the presence or absence of pancreatic duct injury, but the optimal method of assessment is unclear. This study endeavored to evaluate the methods of pancreatic duct assessment in modern practice. MethodsPatients presenting to LAC + USC Medical Center (01/2008–06/2015) with a pancreatic injury were identified (ICD-9 codes). Demographics, clinical data, technique of duct evaluation, and outcomes were analyzed. Results71 patients with pancreatic injury were identified. 21 patients (30%) underwent CT scan (sensitivity 76%). Sixteen (76%) then underwent laparotomy while 5 (24%) were managed successfully nonoperatively. Most (n = 50, 70%) underwent immediate laparotomy. Overall, 66 patients (93%) were managed operatively. The majority were assessed intraoperatively for ductal injury with visual inspection alone (n = 62, 94%). Four (6%) underwent intraoperative pancreatography via duodenotomy/cholecystotomy, which were all inconclusive. ConclusionIn the evaluation of pancreatic duct injury, intraoperative pancreatography is frequently inconclusive and should have a limited role. Clinical suspicion for ductal injury based on intraoperative visual inspection alone should guide the management of pancreatic injuries.
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