Pancreas and Duodenum Injuries: Techniques

Isolated injuries to the pancreas and duodenum from either blunt or penetrating trauma are infrequent, and early mortality is usually due to associated vascular injuries in the upper abdomen. Delays in diagnosis after blunt trauma are less common in the modern era due to the availability of multidetector CT. Pancreatic injuries without involvement of the main duct are managed nonoperatively, while ductal injuries are treated with resection of the body and tail or head and a rare Roux-en-Y reconstruction in most circumstances. The most common complication after resection continues to be a pancreatic fistula. Duodenal perforations are treated with transverse or oblique closure, Roux-en-Y duodenojejunostomy, or resection. Pyloric exclusion with gastrojejunostomy is still used for selected combined pancreatoduodenal or complex duodenal injuries.