What are the surgical options for pancreatic injuries?

Pancreatic injuries can be divided into open penetrating injuries, closed blunt force injuries, and medically induced surgical malpractice. Among them, closed blunt force injuries are not easy to diagnose, and are prone to underdiagnosis and misdiagnosis. The main clinical manifestations of pancreatic injury are internal bleeding and pancreatic fluid peritonitis. The main principles of treating pancreatic injury are complete hemostasis, treatment of combined organ injuries, resection of inactivated pancreatic tissue and adequate drainage. Pancreatic injuries are categorized into open penetrating injuries, closed blunt force injuries, and medically induced surgical malpractice. Open penetrating injuries are caused by the penetration of a foreign body through the pancreas, and are commonly seen in firearm injuries (e.g., bullets), puncture wounds (e.g., daggers), and so on. Medically induced surgical injuries are common in abdominal surgeries, such as splenectomy, etc. Such injuries can usually be avoided by careful surgical operations. Closed blunt force injuries are caused by compression of the pancreas from violence and between the spine, such as from a car accident. Open pancreatic injuries are not difficult to diagnose; gunshot wounds in the upper abdomen or near the umbilicus must be considered as a possibility of pancreatic injury, and it is not difficult to find the site of injury during a dissection.

The diagnosis of closed pancreatic injury is very difficult, and less than half of those who obtain a correct diagnosis before surgery. pancreatic amylase measurement, in patients with pancreatic injury, about half of the patients have elevated serum amylase levels, but the degree of elevation is not consistent with the severity of pancreatic injury. 20% of patients with transected pancreatic injuries have normal serum amylase values. Peritoneal puncture or lavage can be performed to detect amylase in peritoneal puncture fluid or lavage fluid in patients with high suspicion of pancreatic injury and normal serum amylase. Peritoneal puncture fluid amylase measurement has some value in diagnosis. Special tests, abdominal radiographs may show retroperitoneal masses, widened duodenal loops, and abnormal displacement of the stomach and transverse colon. Other tests such as B-mode ultrasound and CT examination, selective abdominal arteriography, retrograde cholangiopancreatography, pancreatic isotope scanning.

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