Due to its anatomical position, traumatic lesions of the pancreas are rare and difficult to diagnose. Diagnosis time is paramount as an increase in duration translates into an increase in morbidity and mortality. Duct lesions are hard to identify on CT, ERCP being the investigation of choice but it is difficult to obtain as it requires highly specialized staff and equipment. Intraoperative macroscopic and palpatory evaluation of the pancreas in a trauma patient should be elective no matter what other lesions are present. The treatment is mainly dictated by this evaluation and is defined as it follows: stage I and II usually require a conservative approach; stage III, IV, and V usually imply resection of the pancreas although recent advances in conservative management have been made through ERCP and pancreatic duct stenting. In these stages, intraoperative evaluation should ensure the ampulla is intact if the head of the pancreas is not resected. Serum amylase and lipase levels do not offer a concrete direction towards a pancreatic lesion. Currently, there is no standard surgical treatment for these stages thus making intraoperative evaluation mandatory. One must remember that post-traumatic pancreatitis exists, which becomes apparent days after the accident.
3. Schurink GW, Bode PJ, van Luijt PA, van Vugt AB. The value of physical examination in the diagnosis of patients with blunt abdominal trauma: a retrowspective study. Injury. 1997; 28:261-265, PMID: 9282178.
12. Vijay A, Abdelrahman H, El-Menyar A, Al-Thani H. Early laparoscopic approach to pancreatic injury following blunt abdominal trauma. J Surg Case Rep. 2014; 12:1–3.
13. Subramanian A, Dente CJ, Feliciano DV. The management of pancreatic trauma in the modern era. Surg Clin N Am. 2007; 87:1515–32.
14. Gomez D, Addison A, De Rosa A, Brooks A, Cameron IC. Retrospective study of patients with acute pancreatitis: is serum amylase still required? BMJ Open.2012;2:e001471
15. Takishima T, Sugimoto K, Hirata M, Asari Y, Ohwada T, Kakita A. Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations. Ann Surg. 1997; 226(1):70-6.
16. Cerwenka H, Bacher H, El-Shabrawi A, Kornprat P, Lemmerer M, Portugaller HR et al. Management of pancreatic trauma and its consequences – guidelines or individual therapy? Hepatogastroenterology. 2007; 54:581–4.
17. Fabian T, Kudsk K, Croce M, Payne L, Mangiante E, Voeller G et al. Superiority of closed suction drainage for pancreatic trauma: A randomized prospective study. Ann Surg. 1990; 211(6):724-8.
18. Knaebel HP, Diener MK, Wente MN, Buchler MW, Seiler CM. Systematic review and meta-analysis of technique for closure of the pancreatic remnant after distal pancreatectomy. Br J Surg. 2005; 92(5):539-46.