During a five-year period, 50 patients were operated on for pancreatic injury. Forty had open trauma and ten closed. Half of each group were treated by drainage alone. Overall mortality was 14%, with all deaths following open injuries due to gunshots. Deaths were more frequent after drainage than after resection. Substantial complications occurred in 70%, with more frequent and more serious morbidity in drained patients. Sump drainage was associated with less morbidity than Penrose drainage. Guidelines for management of pancreatic trauma are (1) resection of sinistral gland for perforating injuries of the body or tail; (2) drainage of perforations of the pancreatic head when the major duct is intact; (3) resection of duodenum and pancreatic head for devitalizing injury of both structures.