Abstract
Ari LappäniemiMeilahti Hospital, Department of Surgery, University of Helsinki, Haartmaninkatu 4,P.O. Box 340, FIN-00029 HUS, FinlandE-mail: ari.leppaniemi@hus.fi Pancreatic and duodenal injuries are rare and, excluding patients with devastating injuries to the pancreaticoduodenal complex and adjacent vascular injuries, can be managed successfully with adequate and determinate exposure during explorative laparotomy, simple surgical procedures, and sound surgical judgment adapted to the demands of the circumstances and the skills of the operating surgeon. Nevertheless, more complex repair techniques, such as distal pancreaticojejunostomy or pyloric exclusion, may be needed for optimal results in more demanding injuries. Although mortality specifically related to the pancreatic or duodenal injury itself is relatively low, postoperative complications are frequent and often associated with delayed diagnosis and treatment. Key words: abdominal trauma, pancreas, duodenum, pancreaticoduodenal injuries
Highlights
Pancreatic and duodenal injuries are not common and their detection can be challenging both preoperatively and during explorative laparotomy. Their protected location in the retroperitoneum can give subtle symptoms and signs in isolated injuries leading to delayed diagnosis and management
Pancreas is a fixed organ in the retroperitoneum that lies against a rigid vertebral column and is prone to crush injuries following blunt trauma
Disruption of the duodenum by blunt trauma can occur by crushing following a direct blow to the abdomen, shearing associated with sudden deceleration, or bursting energy associated with sudden abdominal compression [3]
Summary
Pancreatic and duodenal injuries are rare and, excluding patients with devastating injuries to the pancreaticoduodenal complex and adjacent vascular injuries, can be managed successfully with adequate and determinate exposure during explorative laparotomy, simple surgical procedures, and sound surgical judgment adapted to the demands of the circumstances and the skills of the operating surgeon. More complex repair techniques, such as distal pancreaticojejunostomy or pyloric exclusion, may be needed for optimal results in more demanding injuries. Mortality related to the pancreatic or duodenal injury itself is relatively low, postoperative complications are frequent and often associated with delayed diagnosis and treatment
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