Penetrating Pancreatic Injury

Pancreatic injury following penetrating trauma is a rare but complex problem in trauma surgery. The retroperitoneal location of the pancreas and its intricate anatomic relationship to other vital structures both contribute to this complexity. Accurate intraoperative diagnosis of pancreatic injury can be difficult, making careful and thorough operative exposure paramount. Operative management is guided by the presence of associated injuries and the severity of the pancreatic injury. External drainage, resection, and staged reconstruction when indicated are the pillars of operative management for the majority of injuries. Post-injury complications are common and can include fistula, pancreatitis, abscess, hemorrhage, and pseudocyst. ERCP is central to the management of these complications and can aid in avoiding return to the operating room. Because of the significant morbidity and mortality associated with penetrating pancreatic injury, collaboration among surgical disciplines is warranted to optimize outcome.