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[Pancreatic trauma: a rare but severe event].

INTRODUCTION
High-speed motor vehicle accidents have contributed to an increasing incidence of pancreatic trauma. Early mortality is generally due to associated vascular and other intra-abdominal injury.


MATERIALS AND METHODS
The authors report their experience on pancreatic trauma. Six cases were treated during the last five years. Isolated pancreatic injury was observed only in one case. Two patients received simple external drainage. Two patients required distal pancreatectomy. One patient was mistreated with ligature of distal pancreatic duct and, postoperatively, developed pseudocyst. One patient, with associated duodenal injury, died.


COMMENTS
Serum amylase is often unreliable, whereas abdominal CT scans have the best sensitivity and specificity in detecting pancreatic injury. Abdominal exploration is always recommended in retroperitoneal trauma evaluation; complete pancreas mobilisation is needed to determine the integrity of the major pancreatic duct. Treatment protocols are based on severity of injury: they range from simple drainage to distal pancreatectomy (in presence of distal transection or parenchymal injury with duct injury) and to pancreaticoduodenectomy (in presence of massive injury, devascularisation, destruction of ampulla). Complications are seen in 20 to 35% of patients and the overall mortality secondary to complications ranges from 10 to 20%. Fistulas and pseudocysts are the most common complications.