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Diagnosis and Treatment of Pancreatic Injuries An Analysis of Management Principles

David H. Wisner, MD; Rebekah L. Wold, MD; Charles F. Frey, MD
Arch Surg. 1990;125(9):1109-1113. doi:10.1001/archsurg.1990.01410210035004.
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• Ninety-one pancreatic injuries, 47 from blunt trauma, were reviewed with respect to management principles stressed in qi previous reviews. The pancreatic complication rate was 25%. Blunt injury was suspected preoperatively in only 30%. Even short-term observation led to morbidity. Operations done more than 6 hours after admission had a higher complication rate (45%) than those done less than 6 hours after admission (18%). Penrose drainage without a sump was not associated with increased complications. Distal pancreatectomy was done 32 times; splenectomy was done in only 18 patients. Individual duct ligation was rarely done and did not result in a high fistula rate. Pancreatic stump oversew with nonabsorbable suture was associated with a higher rate of pancreatic complications than absorbable suture (58% vs 30%). Only 56% of patients receiving distal pancreatectomy required hyperalimentation. Postoperative serum amylase values were not useful, and amylase values from drainage fluid predicted complications only when they were above 100 000 U/L. Details of pancreatic trauma management are less important than early operation in minimizing morbidity.

(Arch Surg. 1990;125:1109-1113)


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