Role of intraoperative pancreatography in patients with injury to the pancreas.

Over a 10 year period, 54 patients presented with pancreatic trauma. During the first 5 years of the study, when pancreatography was not utilized for the assessment of pancreatic duct injury, 55 percent of the patients had major pancreatic complications. During the subsequent 5 years, suspected proximal duct injury was evaluated by intraoperative pancreatography. This resulted in a decrease of postoperative morbidity to 15 percent. In addition, there were not postoperative deaths during this period. The reduction in adverse sequelae after pancreatic trauma leads us to support the following principles of treatment: early recognition of pancreatic injury with immediate surgical intervention, complete exploration of the pancreas with the liberal use of intraoperative pancreatography to determine the presence of major duct injury, and the use of techniques which ensure control of duct disruption.