Complex pancreatic injuries.

The majority of pancreatic injuries are minor in nature and can be managed easily and definitively with external drainage. The complexity of management increases significantly when a pancreatic ductal injury is present. It is requisite that thorough preoperative and intraoperative work-up be complete and systematic if injuries are to be properly recognized and managed. Once an injury has been detected, management guidelines based on injury classification can help to provide uniform results with minimal complications. In general, a conservative management scheme is indicated, the goals of such being preservation of pancreatic tissue and minimization of pancreaticoenteric anastomoses. Specific technical maneuvers may vary, but strict adherence to the basic concepts of hemorrhage control, contamination control, accurate pancreatic assessment, judicious resection, and adequate drainage can help to reduce the frequency of complications from these complex injuries.