The operative approach to pancreatic injury.

Major pancreatic trauma is uncommon and often challenging even for the most experienced trauma surgeon. An organized, well-rehearsed operative approach to these injuries represents the surgeon's best defense. This article highlights operative decision-making. Operative assessment is reliable. The integrity of the main pancreatic duct is the major discriminating variable in the management of pancreatic injury. Pancreaticoduodenectomy can be done safely for devitalizing injuries to the head of the pancreas associated with major duodenal and common bile duct injury. For selected cases, distal pancreatectomy with splenic preservation is realistic. The surgeon must have a wide array of procedures from which to select for major complicated pancreatic trauma.