Pancreatic trauma in a defined population.

In a 20-year period, 378 of a 390,000 population were laparotomized following abdominal trauma, and pancreatic injury was found in 27. Together with two nonsurgically treated patients, these gave an average annual incidence of 0.4 cases of pancreatic trauma/100,000 population. Ten of the injuries occurred in the first and 19 in the second decade of the study. The cause was traffic accident in 18 cases and penetrating wound in only two. The patients' median age was 17 years, and 23/29 were males. The pancreatic injury was the only important intraabdominal lesion in 17 patients, but 12 had associated, potentially lethal lesions. The main pancreatic duct was injured in 11/29 patients, most commonly in those with impaired circulation on admission. Six patients died, 5/11 with, and 1/18 without injury to the main pancreatic duct. Mortality was also related to defective preoperative and intraoperative diagnosis. Clinical recognition of isolated pancreatic injury is difficult, as pain and tenderness may be initially minimal. In two of the six fatal cases and four of the 11 with injured main pancreatic duct, the abdominal status was first judged to be normal.