Conservative management of combined pancreatoduodenal injuries.

We have reviewed our recent 12-year experience in treating 62 patients with combined injuries to the pancreas and duodenum; 60 percent were the consequence of penetrating wounds and 40 percent due to blunt trauma. For analysis, grades I through V were assigned to reflect severity of injury. Grade I (16 percent) and II injuries (23 percent) were treated with simple repair and drainage. Grades III (19 percent) and IV (32 percent) were managed primarily by pyloric exclusion, whereas grade V injuries (10 percent) underwent pancreatoduodenectomy. Pancreatic and duodenal complications developed in 35 percent and 2 percent, respectively. The overall mortality was 19 percent; 83 percent died within the first 24 hours from exsanguination or severe head injury. Although no single procedure uniformly applies to the combined pancreatoduodenal trauma, active sump drainage of the pancreas, pyloric exclusion of the duodenum, and early nutritional support through needle catheter jejunostomy are the mainstay treatment principles.