1. Cody Starnes, M.D.

2. ●Kulenkampff in 1882 – 1st to recognize pancreatic
pseudocyst
●Korte in 1905 – 1st to describe pancreatic fistula
following trauma
●Whipple first described pancreaticoduodenectomy in
1935

3. ●Adults – MVC with steering wheel impalement is
most common
●Children – Bicycle handlebars to the epigastrium is
most common

4. ●Total 1268
●Stab 7.5%
●Gunshot 17%
●Shotgun 56%
●All penetrating 18%
●All blunt 18%
●Averages of 5 studies from 1978 to 1991

5. ●Total 1866
oTotal mortality with pancreatic injury is 20.5%
oHemorrhage accounts for 12%
oMultiple Organ Failure accounts for 6%
oOther etiologies account for 3%
●Average of 9 studies from 1967-1997

6. Sources: Stone H, Fabian TBS, et al.: Experiences in the management of pancreatic trauma. J Trauma
21:257, 1981; Jones R: Management of pancreatic trauma. Am J Surg 150:696, 1985; and Graham K,
Mattox KL, Vaughan G, et al.: Combined pancreatoduodenal injuries. J Trauma 19:340, 1979.

7. ●Isolated pancreatic injuries are rare constituting less
than 10% of all pancreatic injuires.
●On average 3-4 additional organ injuries are seen
with pancreatic injuries.

8. ●First described by Benjamin Travers in 1827
Arch Dis Child 1997;77:167-174
Pancreatic
transections, though
uncommon, are
seen when the
pancreas is pushed
against the vertebral
bodies.
The most commonly
implicated vertebra
is L1.

9. ●CT of the abdomen and pelvis has a sensitivity and
specificity of about 80% of picking up pancreatic
injuries.
●Other methods employed include ERCP/MRCP,
MRI, ductography if duct is severed, U/S
●Injuries to the major duct occur in perhaps 15% of
pancreatic trauma and are generally the result of
penetrating wounds.

10. ●Pancreatic Organ Injury Scale: American Association for the Surgery of Trauma
GRADEa INJURY DESCRIPTIONb
●Grade I Hematoma
o Minor contusion without duct injury
o Superficial laceration without duct injury
●Grade II Hematoma
o Major contusion without duct injury or tissue loss
o Major laceration without duct injury or tissue loss
●Grade III Laceration
o Distal transection or parenchymal injury with duct injury
●Grade IV Laceration
o Proximal (to right of superior mesenteric vein) transection or parenchymal injury
●Grade V Laceration
o Massive disruption of pancreatic head
●a Advance one grade for multiple injuries to the same organ.
●b Based on most accurate assessment at autopsy, laparatomy, or radiologic study.
●(Modified with permission from Moore EE, Cogbill T, Malangoni M, et al.: Organ injury
scaling II: Pancreas, duodenum, small bowel, colon, and rectum. J Trauma 30:1427,
1990.)

11. Trauma - 6th Ed. (2008)

12. ●Once drain amylase levels are less than serum the drain
can usually be discontinued in a few days.
●However, the drain should be kept in as long as drain
amylase is greater than serum.
●If postpyloric enteral nutrition is selected, the best
formula is one that is elemental, low in fat, and has a pH
>4.5. (All pertinent studies are from the 1970s-1980s.)
●A prospective study out of the University of Tennessee
compared septic complications between enteral feeds
and TPN following pancreatic trauma with an ISS >15.
The more severe the injury, the more significant was the

13. ●If the injury is isolated to the left of the SMV and at
least 20% of residual pancreatic function can be
preserved, a distal pancreatectomy is in order.

14. ●Performed in only 3% of all
pancreatic traumas.
“Whipple Procedure after Blunt Abdominal
Trauma”
De Kerpel, Wim MD; Hendrickx, Tom MD;
Vanrykel, Jean-Pierre MD; Aelvoet, Chris MD;
De Weer, Frans MD
The Journal of Trauma: Injury, Infection, and
Critical Care Issue: Volume 53(4), October
2002, pp 780-783
Formulated a new algorithm for
the management of pancreatic
trauma
Common indications for trauma
Whipple include
devascularization of pancreatic
head, crushed 2nd portion of
duodenum, disruption of the
ampulla of Vater, transection of

16. ●The most common complication.
●Normal daily pancreatic output is 500-800 mL.
●According to the International Study Group on Pancreatic Fistulas
any volume of output from a drain after 3 days from operation that
has an amylase level three times that of serum levels is the standard
definition of a pancreatic leak.
● “Postoperative pancreatic fistula: An international study group (ISGPF) definition” Claudio Bassi, MD,a Christos Dervenis, MD,b Giovanni
Butturini, MD,a Abe Fingerhut, MD,c Charles Yeo, MD,d Jakob Izbicki, MD,e John Neoptolemos, MD,f Michael Sarr, MD,g William
Traverso, MD,h and Marcus Buchler, MD,i for the International Study Group on Pancreatic Fistula Definition,*Verona, Italy; Athens,
Greece; Poissy, France; Baltimore, Md; Liverpool, United Kingdom; Hamburg, Germany; Rochester, NY; Seattle, Wash; and Heidelberg,
Germany
● Surgery,2005 Volume 138, Number 1, pages 8-13
●A minor pancreatic fistula is defined as output less than 200 mL /d,
and most will resolve within two weeks of injury if adequate drainage
without obstruction is established

17. ●If pancreatic fistulous or drain output persists past
two weeks, then an ERCP is in order for possible
stenting.
Johns Hopkins Medicine: Gastroenterology and Hepatology; http://www.hopkins-
gi.org/GDL_Disease.aspx?CurrentUDV=31&GDL_Cat_ID=AF793A5-B736-42CB-
9E1FE79D2B9FC358&GDL_Disease_ID=0ADCFD83-7DE7-4D53-82F5-6F0C9BFB7F14