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External Pancreatic Fistula Following Abdominal Injury

Robert J. Baker, MD; Robert T. Bass, MD; Rostick Zajtchuk, MD; E. Lee Strohl, MD
Arch Surg. 1967;95(4):556-566. doi:10.1001/archsurg.1967.01330160026004.
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THE incidence of major solid visceral injury and, especially, severe pancreatic injury has been increasing steadily over the past 15 years in keeping with the increase in high-speed automotive trauma. The treatment of wounds of the pancreas, however, has resulted in fewer complications as surgeons have adopted a more aggressive approach toward crushing pancreatic injuries.

Pancreatic fistula is an uncommon complication of trauma, appearing postoperatively in 4% to 6% of patients. Most studies of fistulae have dealt with postoperative leakage of pancreatic juice following drainage or marsupialization of inflammatory pseudocysts, or those which presented as a complication of elective pancreatic or gastroduodenal surgery. The irregular anatomy of the pancreatic ductal system and the fragile nature of the organ combine to make ductal damage or disruption a real hazard in dissection in the vicinity of the head of the gland.

During the past year, 11 patients were admitted to the Trauma


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