One hundred and seventy-five pancreatic injuries were studied, reviewed at Parkland Memorial Hospital over a 20-year period. The mortality for penetrating injuries to the pancreas has remained at approximately 20% because of associated major vessel injuries. Due to more aggressive management of pancreatic injuries, the mortality for blunt trauma of the pancreas has decreased from a previously reported 37% to an overall 16%, and to 8% during the past five years. Mortality for the pancreatic injury is less than 5%. Distal pancreatectomy has been useful for transections of the body of the pancreas, but a Roux-en-Y anastomosis to both ends of the pancreas has been a preferred and satisfactory method of management of the completely transected pancreas in the region of the neck. Pancreaticoduodenectomy has only been performed for combined pancreaticoduodenal injuries.